3D Preoperative Planning in the ER with OsiriX®: When There is No Time for Neuronavigation

Abstract

Abstract:The evaluation of patients in the emergency room department (ER) through more accurate imaging methods such as computed tomography (CT) has revolutionized their assistance in the early 80s. However, despite technical improvements seen during the last decade, surgical planning in the ER has not followed the development of image acquisition methods. The authors present their experience with DICOM image processing as a navigation method in the ER. The authors present 18 patients treated in the Emergency Department of the Hospital das Clínicas of the University of Sao Paulo. All patients were submitted to volumetric CT. We present patients with epidural hematomas, acute/subacute subdural hematomas and contusional hematomas. Using a specific program to analyze images in DICOM format (OsiriX ® ), the authors performed the appropriate surgical planning. The use of 3D surgical planning made it possible to perform procedures more accurately and less invasively, enabling better postoperative outcomes. All sorts of neurosurgical emergency pathologies can be treated appropriately with no waste of time. The three-dimensional processing of images in the preoperative evaluation is easy and possible even within the emergency care. It should be used as a tool to reduce the surgical trauma and it may dispense methods of navigation in many cases.

Is patient-specific pre-operative preparation feasible in a clinical environment? A systematic review and meta-analysis

“…It should also be noted that many authors propose PS preoperative preparation for "difficult" cases (e.g. severely comminuted fractures or cranial base tumours [49] Complete clearance of stones 5/8 (62.5%) -Mucosal perforation 1/8 (12.5%) Gateno et al [20] Deformities corrected at 6 week f/u Xia et al [27] NIP Hislop et al [44] Successful operations (0% residual vessel stenosis) 3/5 (60%) Lu et al [53] 77.8% improvement in symptoms at 9 months f/u No complications Ng et al [47] Complete resection 23/23 (100%) -4.3% had additional neurological deficit post-operatively -1/23 severely disabled due to post-operative complications Dhanda et al [17] 1.43 cm average improvement in mouth openining Fornaro et al [29] Anatomic or satisfactory reduction of fracture 7/7 (100%) -No serious complications Qiu et al [43] Total tumour resection 33/45 (73.3%) -Decrease >10% of effective fibre of pyramidal tract 7/45 (15.6%) Dong et al [28] Resection margins free of tumour in all cases Essig et al [18] 2/3 good results Ferrari et al [48] No Information Provided (NIP) Hu et al [31] NIP Tepper et al [7] NIP Derand et al [16] Surgeons' opinion: Good correlation of plan and surgical steps Calculated reduction in operation time 30min Kanzaki et al [54] No conversion to open Margins free of cancer 3 complicationsprolonged air leak, needed pleurodesis Kerens et al [33] All guides fitted well during real surgery Good stability in all cases at 6 weeks f/u No complications Nam et al [9] Good alignment of lower limb for: CAS: 92.7% -PCS:70.7% Scolozzi [25] Satisfactory reconstruction 2/2 0 complications Shen et al [37] Satisfactory or anatomical reduction in 5/6 (83.3%) cases -No complications (0%) Willaert et al [45] NIP Adolphs et al [14] NIP Desender et al [41] NIP Hsu et al [21] NIP Issa et al [32] No complications Mandel et al [57] NIP Pietsch et al [35] Satisfactory outcome (overall axis within 3 o ) 47/51 (94%) Schweizer et al [36] Improvement of wrist ROM at 1 year f/u Increase of wrist strength by 10% on average No complications (no ...…”

Speeding up PET/MR for cancer staging of children and young adults

“…The proposed breath-hold T1-weighted SPGR sequence can be equally used to expedite whole-body MRI data acquisition of sequential or integrated PET/MR technologies. We utilized OsiriX for image data fusion which allows for image co-registration within less than 500 microns [34]. Others have confirmed the feasibility of this approach [35–37].…”

Smartphone-assisted minimally invasive neurosurgery

“…CT images were processed using the DICOM software OsiriX preoperatively, as described previously. 19 An exclusively endoscopic technique or a combined endoscopic-microscopic technique, both of which were performed with the neuroendoscopic device coupled to a smartphone, was chosen according to the neurosurgeon's preference. A rigid rod lens endoscope (Karl Storz) was used in all patients.…”