Relationship between Intraoperative Findings and Computational Fluid Dynamics Analysis in ICPC Aneurysm presenting Oculomotor Nerve Palsy

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  • 動眼神経麻痺で発症した内頚動脈後交通動脈分岐部動脈瘤における術中所見とCFD解析

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Background and Purpose: Computational fluid dynamics (CFD) analysis is based on vessel region of interest from a "digital clone" produced by MRA, 3D-CTA and 3D-DSA. These angiographic images are not able to reflect extravascular information but intravascular flow, therefore, CFD technique is not able to predict aneurysm wall fragility directly. Here, we present the results of CFD analysis compared with intraoperative findings in a patient with unruptured internal carotid artery-posterior communicating artery bifurcation aneurysm presenting oculomotor nerve palsy. Methods: We investigated the relationship between the aneurysm dome and oculomotor nerve on clipping surgery and CFD results. In CFD analysis, wall shear stress (WSS) at the sites of parent artery, dome and contact zone to oculomotor nerve were calculated using the patient-specific model from 3D rotational angiography. In addition, two kinds of streamlines of blood velocity near the contact zone were evaluated. Results: WSS at the contact point was 0.44Pa, which is lower than that of the dome. 3D streamline of blood velocity was not observed around the contact zone. Surface stream near the contact zone was irregular pattern, however, that of bleb at the opposite side was linear pattern. Conclusion: CFD analysis provided key hemodynamic information that low WSS and irregular surface streamline could be related to the mechanism of the growing component in unruptured cerebral aneurysms.

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