Mathematical modeling of high-flow extra-intracranial bypass in the treatment of a complex cerebral aneurysm

Blagosklonova E.R.

Gammamed-Soft LLC

Dolotova D.D.

Gammamed-Soft, LLC

Arkhipov I.V.

D.V. Skobeltsyn Research Institute of Nuclear Physics M.V. Lomonosov Moscow State University

Polunina N.A.

Sklifosovsky Research Institute for Emergency Care

Stepanov V.N.

Sklifosovsky Research Institute for Emergency Care

Krylov V.V.

A.I. Evdokimov Moscow State Medical University;
N.V. Sklifosovsky Scientific and Research Institute of Emergency Medicine

SPIN RSCI: 6115-4291
ORCID: 0000-0002-2706-3496

Gavrilov A.V.

D.V. Skobeltsyn Research Institute of Nuclear Physics M.V. Lomonosov Moscow State University

Mathematical modeling of high-flow extra-intracranial bypass in the treatment of a complex cerebral aneurysm

Authors:

Blagosklonova E.R., Dolotova D.D., Arkhipov I.V., Polunina N.A., Stepanov V.N., Krylov V.V., Gavrilov A.V.

More about the authors

Journal: Burdenko's Journal of Neurosurgery. 2022;86(3): 23‑32

DOI: 10.17116/neiro20228603123

Downloaded: 43

To cite this article:

Blagosklonova ER, Dolotova DD, Arkhipov IV, Polunina NA, Stepanov VN, Krylov VV, Gavrilov AV. Mathematical modeling of high-flow extra-intracranial bypass in the treatment of a complex cerebral aneurysm. Burdenko's Journal of Neurosurgery. 2022;86(3):23‑32. (In Russ., In Engl.)
https://doi.org/10.17116/neiro20228603123

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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.

Keywords:

hemodynamic analysis

intracranial aneurysms

complex aneurysms

cerebral circulation

bypass surgery

computational fluid dynamics

preoperative planning

EC-IC bypass

Authors:

Blagosklonova E.R.

Gammamed-Soft LLC

Dolotova D.D.

Gammamed-Soft, LLC

Arkhipov I.V.

D.V. Skobeltsyn Research Institute of Nuclear Physics M.V. Lomonosov Moscow State University

Polunina N.A.

Sklifosovsky Research Institute for Emergency Care

Stepanov V.N.

Sklifosovsky Research Institute for Emergency Care

Krylov V.V.

A.I. Evdokimov Moscow State Medical University;
N.V. Sklifosovsky Scientific and Research Institute of Emergency Medicine

SPIN RSCI: 6115-4291
ORCID: 0000-0002-2706-3496

Gavrilov A.V.

D.V. Skobeltsyn Research Institute of Nuclear Physics M.V. Lomonosov Moscow State University

Received:

17.03.2022

Accepted:

25.03.2022

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