The Art of Cerebral Aneurysms-3 Decades of Postoperative Drawings: Review, Classification, and Efficacy for Training

OBJECTIVE: To focus on postoperative drawings of aneurysms, which serve as visual records and teaching tools for neurosurgeons and reinforce three-dimensional vascular configurations that are specific for different cerebral aneurysms, and examine experience with this technique, particularly in regard to the training of neurosurgical residents. METHODS: After performing craniotomy for aneurysm treatment, formal postoperative drawings were created and reviewed. Microsurgical issues graphically highlighted included the totality of aneurysmal dome anatomy, position of visible and hidden branch vessels, rupture points, clipping techniques, and location of adjacent cranial nerves. Drawings were cataloged and categorized according to location. RESULTS: Over a 28-year period, during a continuous series of 1480 microsurgically treated aneurysms, 619 drawings (221 of anterior cerebral artery, 154 of middle cerebral artery, 214 of internal carotid artery, 30 of posterior circulation) were created. Postoperative drawings in each location were presented and reviewed. Drawings demonstrated site-specific microsurgical approaches, morphologies, and points of obscuration and rupture. CONCLUSIONS: Creation and review of postoperative drawings are important adjuncts for the development of three-dimensional understanding of aneurysmal anatomy. This classic art has impact in the digital age and allows patterns of morphology, projection, and anatomy to be reinforced. Surgical atlases created from postoperative drawings function as reference and teaching tools. The creation of postoperative drawings should be a routine part of the training and methodology of vascular neurosurgeons.