Patient-Specific 3D-Printed Models and Mixed-Reality Head-Mounted Display Visualization for Aneurysm Clip Ligation Planning: A Methodological Workflow Study

Brain Sciences, vol. 16, pp. 932

Abstract

BACKGROUND: Mixed-reality head-mounted display (MR-HMD) visualization and 3D-printed models may improve three-dimensional visualization in neurosurgical planning. Detailed, reproducible descriptions of the workflows, technical requirements, and practical limitations of these techniques in aneurysm clip ligation planning remain limited. METHODS: Between February 2020 and June 2021, patient-specific MR-HMD visualizations and 3D-printed models were generated for 29 patients undergoing elective surgical clip ligation of intracranial aneurysms. CT and 3D rotational angiography were fused to create patient-specific holograms for MR-HMD visualization and 3D-printed models. All cases underwent standardized modality-specific processing. Preparation and manufacturing times as well as recorded workflow-related usability observations, technical advantages, and limitations were assessed. RESULTS: The mean total preparation time (mean ± standard deviation, SD) was 40.6 ± 10.3 min for MR-HMD visualization and 108.8 ± 17.8 min for 3D-printed models, excluding printing, washing, and curing time. The average printing time for 3D-printed models was 894.9 ± 41.6 min. MR-HMD setup in the operating room averaged 7.0 ± 2.8 min. Identified limitations included manual hologram registration and repositioning after table or patient position changes, as well as the inability to track instruments or interact with the hologram. CONCLUSIONS: Both modalities could be integrated into a standardized patient-specific workflow and serve complementary functions. MR-HMD visualization supported flexible short-term visualization, whereas 3D-printed models provided a physical model for clip planning and patient education at the cost of longer preparation and production. These findings support a combined workflow in which modality selection is guided by clinical tasks and time constraints.

Authors 10

1. Joshua Haegler corresponding

   TUM Klinikum · Kantonsspital Aarau · Technical University of Munich

   Affiliation as printed

   Department of Neurosurgery, Kantonsspital Aarau, 5001 Aarau, Switzerland

   Department of Neurosurgery, TUM Medical School, Technical University of Munich, 81675 Munich, Germany

2. Javier Añon

   Kantonsspital Aarau

   Affiliation as printed

   Department of Radiology, Division of Neuroradiology, Kantonsspital Aarau, 5001 Aarau, Switzerland

3. Gwendoline Boillat

   Kantonsspital Aarau

   Affiliation as printed

   Department of Neurosurgery, Kantonsspital Aarau, 5001 Aarau, Switzerland

4. Stefanie Bauer

   Kantonsspital Aarau

   Affiliation as printed

   Department of Neurosurgery, Kantonsspital Aarau, 5001 Aarau, Switzerland

5. Debora Roethlisberger

   Kantonsspital Aarau

   Affiliation as printed

   Department of Neurosurgery, Kantonsspital Aarau, 5001 Aarau, Switzerland

6. Gerrit Alexander Schubert Aachen Department of Neurosurgery

   Kantonsspital Aarau · RWTH Aachen University

   Affiliation as printed

   Department of Neurosurgery, Kantonsspital Aarau, 5001 Aarau, Switzerland

   Department of Neurosurgery, RWTH Aachen University, 52062 Aachen, Germany

7. Hans‐Jakob Steiger

   Kantonsspital Aarau · Heinrich Heine University Düsseldorf

   Affiliation as printed

   Department of Neurosurgery, Heinrich-Heine-University, 40225 Düsseldorf, Germany

   Department of Neurosurgery, Kantonsspital Aarau, 5001 Aarau, Switzerland

8. Luca Remonda

   University of Bern · Kantonsspital Aarau

   Affiliation as printed

   Department of Radiology, Division of Neuroradiology, Kantonsspital Aarau, 5001 Aarau, Switzerland

   Faculty of Medicine, University of Bern, 3012 Bern, Switzerland

9. Serge Marbacher

   University of Bern · Kantonsspital Aarau

   Affiliation as printed

   Department of Neurosurgery, Kantonsspital Aarau, 5001 Aarau, Switzerland

   Faculty of Medicine, University of Bern, 3012 Bern, Switzerland

10. Lukas Andereggen corresponding

    University of Bern · Kantonsspital Aarau

    Affiliation as printed

    Department of Neurosurgery, Kantonsspital Aarau, 5001 Aarau, Switzerland

    Faculty of Medicine, University of Bern, 3012 Bern, Switzerland