gms | German Medical Science

64th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

26 - 29 May 2013, Düsseldorf

Maximum-Minimal-Protocol: virtual 3D-planning and simulation using a cost-efficient DICOM imaging software

Meeting Abstract

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  • Philippe Dodier - Neurochirurgische Abteilung, Landesklinikum St.Pölten
  • Firas Hammadi - Klinik für Neurochirurgie, Universitätskliniken des Saarlandes, Homburg/Saar
  • Karl Ungersböck - Neurochirurgische Abteilung, Landesklinikum St.Pölten

Deutsche Gesellschaft für Neurochirurgie. 64. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Düsseldorf, 26.-29.05.2013. Düsseldorf: German Medical Science GMS Publishing House; 2013. DocMO.08.04

doi: 10.3205/13dgnc065, urn:nbn:de:0183-13dgnc0650

Published: May 21, 2013

© 2013 Dodier et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: Rapid advances in multimodal medical imaging techniques have led to significant improvements in 3D visualization technologies and supported the exact preoperative planning of keyhole approaches. Until now, these technologies are reserved to highly specialized centers with the necessary financial and personal resources. We present our experiences planning and simulating complex approaches to intracranial lesions with an affordable, cost-efficient and reliable 3D Imaging reconstruction software. The authors report no conflict of interest concerning the materials used in this study.

Method: Using the 64-bit, FDA cleared version of the OsiriX software, an open source software DICOM viewer and PACS workstation, multimodal imaging data were processed, a 3-dimensional virtual reality model was reconstructed using the volume rendering method. We developed a simple 5-step algorithm (Maximum-Minimal Protocol „MMP“) aiming at acquiring following information:

3D reconstruction of intracranial lesions, angioarchitechture, geometrical and volumetrical evaluation, visualization of adjacent structures;
analysis of superficial cortical anatomy;
placement and size of planned craniotomy, if possible minimally invasive;
skin incision in consideration of the course of important subcutaneous vessels;
this information ultimately leading to the planing of the safest surgical trajectory and patient head positioning

Results: 42 preoperative 3D models were reconstructed. In all cases geometrical and volumetrical data were acquired. Time of planning could significantly be reduced after a training period of a few weeks from more than 45 min to less than 15 min. Considerable intraoperative time savings due to better preparation were subjectively noticed, quantitative assessment is still ongoing.

Conclusions: Preoperative 3D VR models correlated to intraoperative anatomical landmarks, were used to plan skin incision and craniotomies, in cases of significant CSF shift and distortion of neuronavigation data, the simulations helped correcting trajectories and faster localisation of the lesion. 3D virtual imaging using OsiriX for surgical planning is simple, cost-efficient and considerably time saving, supporting intraoperative orientation, and is helpful for successful resection.