Marker-CT assisted surgery using household key ring: A simple substitute to frameless stereotaxy for developing...

Area of Science:

• Neurosurgery
• Medical Imaging
• Surgical Navigation

Background:

• Advanced operative localization systems like stereotactic frames and neuronavigation are often inaccessible in developing countries due to high costs.
• A modified, cost-effective computed tomography (CT)-assisted technique using a household key ring is presented as an alternative.

Observation:

• A key ring is used to mark the scalp entry point for intracranial lesions, ensuring the shortest perpendicular trajectory.
• Helical CT scans are acquired, with reconstructions performed in two perpendicular planes relative to the key ring.
• Measurements from the CT scan, referencing the key ring's radiologic pointers, determine the precise entry point and depth for surgical approach.

Findings:

• The key ring method offers simplicity, conforms to the head's shape, and minimizes CT artifacts compared to other markers.
• The technique allows for effortless estimation and a three-dimensional visual impression of the lesion's location.
• The shortest perpendicular depth of approach is accurately determined using this key ring-based localization.

Implications:

• This accessible technique facilitates operative localization of superficial intracranial lesions for biopsy and resection in resource-limited settings.
• It provides a practical solution for neurosurgical procedures where advanced technology is unavailable.
• The method's ease of use and affordability can significantly improve surgical outcomes in underserved regions.