A CFD-based framework to evaluate surgical alternatives in cerebral aneurysms

Computational Fluid Dynamic (CFD) simulations on patient-specific geometries may guide the choice between alternative surgical interventions, especially in the case on non-conventional treatments. We propose and formalise a CFD-based framework to evaluate alternative surgical interventions. It provides surgeons with the CFD analyses of different surgical options, so that they may decide the best strategy based on quantitative haemodynamic parameters for each surgical alternative. The proposed framework is largely automatised and, when it necessarily requires the intervention of a human operator due to the patient-specific nature, this intervention is well-formalised to reduce inter-operator variability and guarantee reproducibility. To provide preliminary evidence on the effectiveness of the framework, we present its application to complex Intracranial Aneurysms (IAs), which involve less than 5% of brain aneurysms, but are usually at a high risk of rupture and often show unexpected response to therapy. Complex IAs include aneurysms that cannot be treated with conventional therapies, such as neck clipping, sac coiling or stenting, while instead their treatment requires the sacrifice of the parent artery. In particular, we refer to a giant cavernous sinus aneurysm inside the left internal carotid artery. Results show the ability of the framework to provide haemodynamic quantitative evaluations, which can be useful additional information for the neurosurgeon towards optimal surgical planning.