Muirhead, William;
(2023)
Innovation in the Microsurgical Repair of Cerebral Aneurysms.
Doctoral thesis (M.D(Res)), UCL (University College London).
Abstract
This thesis is divided into two parts. In the first part, we examine the current state of the art in cerebral aneurysm microsurgery and consider the unsolved technical challenges. In the second part, we examine three specific solutions to those technical challenges. We begin with a historical vignette exploring the historical development of microsurgical repair of cerebral aneurysms. We examine the sources of intraoperative harm by means of systematic review of the literature and then ascertain the views of experts using thematic analysis of a survey of experienced neurovascular surgeons. We identify three areas of technical challenge for which technological solutions could be applied: tissue handling and microsurgical skills; intraoperative rupture; and brain retraction. In response to the challenges identified in the first part of the thesis, the second part addresses three specific solutions. The first of these is the role of simulation to address challenges of training in aneurysm microsurgery. We assess the use of a novel surgical simulator by trialling it with both experts and novices. The second solution is the use of machine learning to recognize features within the surgical scene. The aim of this strand is to automate the identification of steps of the operation that are high risk for rupture and to offer landmarks to recalibrate neuronavigation systems. The third solution is the use of novel neuromonitoring to detect when the brain is at risk of retraction injury. We examine the use of electrocorticography in a mouse model to detect electrical markers of ischaemia. We also outline the design of clinical trial presently enrolling patients at the National Hospital for Neurology and Neurosurgery to validate this technique in humans. The final chapter consolidates the previous six to draw the thesis to a conclusion.
| Type: | Thesis (Doctoral) |
|---|---|
| Qualification: | M.D(Res) |
| Title: | Innovation in the Microsurgical Repair of Cerebral Aneurysms |
| Language: | English |
| Keywords: | Innovation, Cerebral Aneurysm, Microneurosurgery |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10172146 |
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