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Original research
Current and future usefulness and potential of virtual simulation in improving outcomes and reducing complications in endovascular treatment of unruptured intracranial aneurysms
  1. Johanna Maria Ospel1,2,
  2. Nima Kashani3,
  3. Arnuv Mayank2,
  4. Thomas Liebig4,
  5. Johannes Kaesmacher5,
  6. Markus Holtmannspötter6,
  7. Jai Shankar7,
  8. Mohammed A Almekhlafi2,3,
  9. Alim P Mitha2,3,8,
  10. John H Wong2,3,8,
  11. Mayank Goyal2,3
  1. 1 Department of Radiology, Universitatsspital Basel, Basel, Switzerland
  2. 2 Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
  3. 3 Department of Radiology, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
  4. 4 Department of Neuroradiology, LMU Munich, Munich, Germany
  5. 5 Department of Neuroradiology, University Hospital Bern, Bern, Switzerland
  6. 6 Department of Neuroradiology, Klinikum Nürnberg, Nürnberg, Germany
  7. 7 Department of Radiology, University of Manitoba, Winnipeg, Nova Scotia, Canada
  8. 8 Department of Neurosurgery, University of Calgary, Calgary, Alberta, Canada
  1. Correspondence to Dr Mayank Goyal, Department of Diagnostic Imaging, University of Calgary, Calgary, Canada; mgoyal{at}


Background Simulation training has been used in the aviation industry and surgical specialties for many years, but integration into neurointerventional practice is lagging behind.

Objective To investigate how neurointerventionalists perceive the usefulness and limitations of simulation tools for the treatment of unruptured intracranial aneurysms (UIAs), and to identify simulation applications that were perceived to be most valuable for endovascular UIA treatment.

Methods A web-based international multidisciplinary survey was conducted among neurointerventionalists. Participants were asked for their perceptions on the usefulness of current simulation tools and the potential impact of future simulation tools in endovascular UIA treatment. They identified simulation applications that could add most value to endovascular UIA treatment and help to specifically reduce endovascular UIA treatment complications.

Results 233 neurointerventionalists from 38 countries completed the survey, most of whom (157/233 (67.4%)) had access to a simulator as a trainee, but only 15.3% used it frequently. Most participants (117/233 (50.2%)) considered currently available simulation tools relatively useful for endovascular UIA treatment, with greater value for trainees than for staff. Simulation of new devices (147/233 (63.1%)) and virtual practice runs in individual patient anatomy (119/233 (51.1%)) were considered most valuable for reducing endovascular UIA treatment complications.

Conclusion Although neurointerventionalists perceived currently available simulation tools relatively useful, they did not use them regularly during their training. A priori testing of new devices and practice runs in individual patient anatomy in a virtual environment were thought to have the greatest potential for reducing endovascular UIA treatment complications.

  • aneurysm
  • coil
  • complication
  • technique
  • technology

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  • Twitter @johanna_ospel, @nimakashani, @AlmekhlafiMa

  • Contributors MG, JMO: conceptualization, drafting, and critical revision of the manuscript. Remaining authors: critical revision of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Map disclaimer The depiction of boundaries on this map does not imply the expression of any opinion whatsoever on the part of BMJ (or any member of its group) concerning the legal status of any country, territory, jurisdiction or area, or of its authorities. This map is provided without any warranty of any kind, either expressed or implied.

  • Competing interests MG is a consultant for Medtronic, Stryker, Microvention, GE Healthcare, Mentice. JMO is supported by the University of Basel Research Foundation, JB Rhyner Foundation, and Freiwillige Akademische Gesellschaft Basel.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information.