Cost-effective Tangible Rehearsal Interface for Microsurgical Clipping of Intracranial Aneurysm

Microsurgical clipping (MC) is widely used for the treatment of intracranial aneurysms (IA). However, it is a high risk for neurosurgeons to perform this operation due to the complex intracranial anatomy, limited microscopic view, and confined operational space. To tackle the above issues, meticulous preoperative rehearsal is in urgent need to improve the neurosurgeons’ perception of patient-specific anatomy while designing the optimal surgical plan, which can greatly enhance the patients’ safety. Most existing MC simulators only support limited interaction methods, such as haptic devices, leading to substantial differences between the training experience and actual surgical situations. To this end, we present a mixed reality (MR) interface for IA MC rehearsal, which can provide neurosurgeons with a more immersive experience. Firstly, considering the labor-intensive labeling cost of reconstructing a 3D full-brain vascular model from CTA images, the simulator employs a cost-effective specific-to-general vessel stitching technique to generate 3D lesion-specific IA geometric models, which replaces normal vascular segments in a standard brain with a personalized-specific operating region by a scaling-constrained iterative closest point (ICP) algorithm. Besides, we design a marker-based tracking method allowing accessible natural human-computer interaction using real surgical instruments which can fuse virtual anatomy and real operation environments, enhancing the users’ spatial perception and tangible stimuli. Additionally, to ensure simulation stability while providing visually plausible clipping operations, we develop a collision distance constrained position-based dynamics (PBD) method with low-resolution sampling particles to simulate the deformation of aneurysm vessels. Quantitative experiments demonstrate the accuracy of our surgical instruments tracking and vessel deformation simulation, which can also fulfill the real-time performance of MC rehearsal. User study indicates that virtual rehearsals significantly improve spatial awareness and dexterity in handling aneurysms, and have the great potential to be applied in practical applications.