[Mathematical modeling of high-flow extra-intracranial bypass in the treatment of a complex cerebral aneurysm]
E R Blagosklonova1, D D Dolotova1,2, I V Arkhipov1,3
1Gammamed-Soft LLC, Moscow, Russia.
Background:
Intracranial aneurysms (IAs) pose a high risk of spontaneous subarachnoid hemorrhage. In the most complex cases, the only way to exclude the aneurysm from the circulation is to perform a high-flow extracranial-to-intracranial bypass, thus creating a new bloodstream. This avoids severe ischemic complications; however, it requires careful consideration of individual anatomy and hemodynamic parameters. Computational fluid dynamics (CFD) can be of great help in planning such a surgery by creating 3D patient-specific models of cerebral circulation.
Objective:
Assessment of the perspectivity of high-flow extracranial-to-intracranial bypass planning using computational modeling.
Material And Methods:
In this research work, we have applied the CFD methods to a patient with a giant thrombosed IA of the internal carotid artery (ICA). Preoperative CTA images and Gamma Multivox workstation were used to create a 3D model with current geometry and three additional models: Normal anatomy (no IA), Occlusion (with ligated ICA), Virtual bypass (with bypass and ligated ICA). The postoperative data were also available. Boundary conditions were based on PC-MRI measurements. Calculation of hemodynamics was conducted with a finite element package ANSYS Workbench 19.
Results:
The results demonstrated an increase in the blood flow on the affected side by more than 70% after the virtual surgery and uniformity of flow distribution between the affected and contralateral sides, indicating that the treatment is likely to be efficient. Later, postoperative data confirmed that.
Conclusion:
The study showed that virtual preoperative CFD modeling could significantly simplify and improve surgical planning.
