Shrivastava Adesh, Mishra Rakesh, Mittal Amol, Chegondi Ranjith, Baniya Mukesh, Agrawal Amit
Department of Neurosurgery, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India.
Asian J Neurosurg. 2025 Apr 15;20(3):529-534. doi: 10.1055/s-0045-1808061. eCollection 2025 Sep.
Neurosurgical practices have evolved from exploratory techniques requiring extensive craniotomies to more refined methods facilitated by advanced imaging technologies. The advent of neuronavigation systems and modern imaging modalities has enabled precise localization of intracranial lesions, allowing for minor skin and craniotomy flaps, thereby promoting minimally invasive approaches. This study aims to evaluate the efficacy of open-source Digital Imaging and Communications in Medicine (DICOM) software in preoperative planning for keyhole neurosurgical procedures, particularly in resource-limited settings where traditional navigation systems may not be available.
The primary objective was to assess the utility of open-source DICOM software in planning keyhole surgeries, focusing on parameters such as incision length, lesion identification accuracy, operative time, blood loss, bone loss, craniotomy size, resection extent, recovery rate, and complication rates compared with traditional methods.
A retrospective analysis was conducted on 176 patients undergoing keyhole procedures using DICOM software versus a control group of 172 matched patients. Preoperative imaging requirements included high-resolution volumetric scans (magnetic resonance imaging and computed tomography) for accurate three-dimensional (3D) reconstruction. The DICOM software enabled interactive 3D visualization and variable windowing for enhanced preoperative and intraoperative planning.
The keyhole technique resulted in significantly smaller incision lengths (50 ± 12 vs. 200 ± 20 mm, = 0.001) and craniotomy surface areas (9 ± 2 vs. 120 ± 14 cm , = 0.001) compared with conventional methods. The mean duration of surgery was reduced (140 ± 28 vs. 345 ± 32 minutes, = 0.002), with a lower incidence of wound-related complications in the test group (3 vs. 21, = 0.001).
This study demonstrates that accessible DICOM software can effectively support neurosurgeons in executing keyhole procedures and promoting minimally invasive techniques in settings with limited resources. Regular use of this method enhances surgical precision and improves patient outcomes by reducing surgical trauma and recovery times.
神经外科手术实践已从需要广泛开颅的探索性技术发展到由先进成像技术推动的更精细方法。神经导航系统和现代成像方式的出现使得颅内病变能够精确定位，从而允许较小的皮肤切口和开颅皮瓣，进而推动了微创方法的发展。本研究旨在评估开源医学数字成像和通信（DICOM）软件在锁孔神经外科手术术前规划中的有效性，特别是在传统导航系统可能无法使用的资源有限的环境中。
主要目的是评估开源DICOM软件在锁孔手术规划中的效用，重点关注与传统方法相比的切口长度、病变识别准确性、手术时间、失血量、骨质损失、开颅大小、切除范围、恢复率和并发症发生率等参数。
对176例使用DICOM软件进行锁孔手术的患者与172例匹配的对照组患者进行回顾性分析。术前成像要求包括高分辨率容积扫描（磁共振成像和计算机断层扫描）以进行精确三维（3D）重建。DICOM软件实现了交互式3D可视化和可变窗口化，以增强术前和术中规划。
与传统方法相比，锁孔技术的切口长度（50±12 vs. 200±20mm，P = 0.001）和开颅表面积（9±2 vs.
120±14cm²，P = 0.001）明显更小。手术平均持续时间缩短（140±28 vs. 345±32分钟，P = 0.002），试验组伤口相关并发症发生率较低（3例 vs
21例，P = 0.001）。
本研究表明，可获取的DICOM软件能够有效地支持神经外科医生实施锁孔手术，并在资源有限的环境中推广微创技术。经常使用这种方法可提高手术精度，并通过减少手术创伤和恢复时间来改善患者预后。
