Editorial. Neurosurgical planning in a low-resource setting using free open-source three-dimensional volume-rendering software

Abstract

lanning how to conduct neurosurgery is a daunting task, especially for trainees and young neurosurgeons. Inexperience can result in inappropriate incisions, inadequate craniotomies, and difficult surgeries. As early as 1998, neurosurgeons developed the means of creating three-dimensional (3D) reconstructions based on imaging technologies to address this problem. 1 Neuronavigational systems, such as Stealth (Medtronic) and Curve (Brainlab), are useful adjuncts that enable accurate (mean error < 1.5 mm) surgical planning as well as real-time intraoperative orientation. 2 Unfortunately, these systems are often expensive and not readily available to all institutions, especially those in low-to middle-income countries.Other navigational workstations devoted solely to surgical planning may be effective, but they are bulky and require dedicated areas in the hospital where they can be used. [3][4][5][6][7] Commercial software, such as OsiriX (Pixmeo) and radiANT (Medixant), are available and have been shown to be useful in 3D reconstruction of cortical topography, 8 volume rendering, 9 and preoperative planning of neurosurgical cases. 10 Unfortunately, institutions without adequate resources cannot afford licenses for their usethus the need for low-cost, readily available software. In this editorial, we describe how we were able to use Horos (Horos Project), a free, open-source, readily downloadable program for planning cranial neurosurgery.

Simulation of surgery for supratentorial gliomas in virtual reality using a 3D volume rendering technique: a poor man's neuronavigation

“…19,32 Thus, this technique is invaluable in resource-constrained countries where other forms of expensive image-guided surgery tools, namely, neuronavigation systems and intraoperative MRI, are not readily available. 20 Furthermore, we found the images generated by this method to be handy for teaching residents during video conferences amid the ongoing COVID-19 pandemic. 36 The rapid development, availability, and application of 3D printing technology in neurosurgery has revolutionized neurosurgical teaching and planning.…”

“…Important ones in use include RadiAnt, Horos, and OsiriX. [19][20][21][31][32][33][34] RadiAnt works on the Microsoft Windows operating system as well as on the Macintosh operating system while OsiriX and Horos are available for the Macintosh operating system only. RadiAnt is entirely free, as is Horos, while OsiriX is a paid software.…”

“…Most are still not widely available, especially in resource-constrained countries. 19,20 The 3D volume-rendering (VR) technique allows large volumes of data generated by modern CT and MR scanners to be viewed in a 3D virtual space. 21 This technique is now readily available as a tool in several DICOM viewer software programs available online, namely, OsiriX (www.osirix-viewer.com), Horos (www.horosproject.org), and RadiAnt (Medixant).…”

“…21 This technique is now readily available as a tool in several DICOM viewer software programs available online, namely, OsiriX (www.osirix-viewer.com), Horos (www.horosproject.org), and RadiAnt (Medixant). [19][20][21][22][23][24][25] The different aspects of the ABBREVIATIONS HGG = high-grade glioma; LGG = low-grade glioma; VR = volume rendering.…”

“…Compared with other techniques, this technique (as a form of image-guided surgery) is inexpensive and readily available. 20 The clinical application of the 3D reconstruction technique in neurosurgery was demonstrated as early as 1998. 26 Since then, several series have described its clinical application in different subspecialties of neurosurgery, such as vascular, skull base, spine, and tumors.…”