Optimizing Transorbital Approaches for Acom Aneurysms Through Virtual Reality Simulation

Sunday, May 5, 2024

4:33 PM – 4:35 PM CT

Location: S405a

Presenting Author(s)

Edinson Najera

Neurosurgery Fellow
Neurosurgery Department at Lehigh Valley Health Network

Co-Author(s)

Adam Alayli

Medical Student
University of South Florida Morsani College of Medicine
Tampa, FL, US
Walter C. Jean, n/a

Chair of Neurosurgery
Lehigh Valley Health Network
Allentown, Pennsylvania, United States
HP

Hayes Patrick, n/a

Neurosurgery Resident
LHNH, United States
Keaton F. Piper, MD

Resident
University of South Florida
Tampa, Florida, United States
MS

Miguel Saez-Alegre, MD PhD

Skull Base Fellow
Mayo Clinic, United States

Disclosure(s):

Edinson Najera: No financial relationships to disclose

Introduction: The transorbital approach offers a promising minimally invasive corridor for Acom aneurysms clipping. This study aims to quantify the surgical freedom (AOF) achievable through inferior globe retraction using a VR-based system and assess the impact of orbital rim removal on surgical outcomes.

Methods: A VR-based system simulated the transorbital approach for Acom aneurysms clipping in 30 virtual patients. The study compared techniques with and without the removal of the orbital rim to establish an adequate surgical corridor, defined by an area of freedom (AOF) of 550mm2. By using patient-specific model in virtual reality, we calculate the AOF and globe inferior retraction needed to achieve a sufficient surgical corridor. One Acom aneurysm clipping was selected to illustrate the surgical application of the findings.

Results: In the cohort without rim removal, retractions of 5mm and 10mm resulted in average AOFs of 341.2 mm and 588.9 mm, respectively. Only 4 out of 30 cases (13.33%) reached the desired AOF of 550mm2, requiring an average displacement of 10.5 mm. Globe penetration through the orbital floor was observed in 20 instances (66.67%).
In the cohort with rim removal, a notable enhancement in surgical freedom was observed. The mean AOF at retractions of 5mm and 10mm were 667.1 mm2 and 902.5 mm2, respectively. Remarkably, 26 out of the 30 cases (86.67%) achieved the desired AOF threshold of 550mm2, necessitating a mean retraction of only 4.37 mm. Globe penetration occurred in 3 cases (10%), averaging 4.56mm below the orbital floor.
The removal of the orbital rim significantly enhances surgical freedom and safety during transorbital Acom aneurysms clipping.

Conclusion : Orbital rim removal in the transorbital approach markedly enhances surgical freedom and reduces globe penetration risks. This VR-based study suggests its potential as a crucial technique for optimizing surgical outcomes in Acom aneurysm surgery.