Middle Cerebral Artery Aneurysm Clipping With Immersive 360° Virtual Reality Model: 2-Dimensional Operative Video

This is a 50-yr-old female who presented with severe headaches and was found to have an unruptured middle cerebral artery (MCA) aneurysm. She was taken to the operating room for microsurgical clipping. Prior to surgery, an interactive 360° virtual reality (VR) model (Surgical Theatre Inc) rendered from the patient's volumetric computed tomography (CT) angiography (CTA) was used for patient education and operative planning. The aneurysm was located at the MCA trifurcation, and the VR model was used to rehearse clip options prior to surgery. A right pterional craniotomy was performed with a dissection through the sylvian fissure down the M1 segment of the MCA for proximal control. The surgical clips are placed and highlighted in the virtual platform simultaneously. Doppler and indocyanine green (ICG) confirmed patent flow through the MCA trifurcation. A postoperative angiogram confirmed no aneurysm filling. The immersive 360° VR models of pre- and postoperative CTA were shown to the patient at the 1-mo follow-up. The case presented here demonstrates the utilization of the 360° VR model for patient education, preoperative planning, and intraoperative visualization. It is imperative to remain flexible during surgery to change the strategy based on the aneurysm anatomy intraoperatively. Importantly, the interactive 360° VR model allowed for a detailed evaluation of the patient-specific anatomy prior to surgery and helped understand the complex anatomy in high resolution. The patient consented to the procedure and publication of this video for educational purposes.