Application of 3D Slicer-based three-dimensional visual surgical planning in endoscopic optic canal decompression surgery: a prospective randomised controlled study

OBJECTIVE: To evaluate the value of three-dimensional visualization preoperative planning based on the open-source software 3D Slicer in endoscopic endonasal optic nerve decompression for traumatic optic neuropathy. METHODS: A prospective randomized controlled study was conducted. A total of 48 patients with traumatic optic neuropathy who underwent endoscopic endonasal optic nerve decompression at the Affiliated Eye Hospital of Nanchang University between January 2023 and June 2025 were enrolled and randomly assigned to an experimental group (3D Slicer-based three-dimensional visualization planning, n = 25) and a control group (conventional two-dimensional CT planning, n = 23). The primary outcome measures included operative time, intraoperative misjudgment rate, complication rate, surgeon's subjective score (5-point Likert scale), and visual improvement at 3 months postoperatively. Continuous data were analyzed using independent-sample t-test or Mann-Whitney U test, and categorical data were analyzed using Fisher's exact test. RESULTS: There were no statistically significant differences in baseline characteristics or preoperative visual acuity grade between the two groups (P > 0.05). The operative time was significantly shorter in the experimental group than in the control group (129.4 ± 11.6 min vs. 150.7 ± 20.4 min, P < 0.001). Postoperative visual acuity improved significantly compared with preoperative values in both groups (experimental group: P < 0.001; control group: P = 0.003), but the intergroup difference in the grade of visual improvement was not statistically significant (P = 0.439). The intraoperative misjudgment rate was 0% (0/25) in the experimental group and 13.0% (3/23) in the control group, with no statistically significant difference (P = 0.24). The incidence of cerebrospinal fluid leakage was 4.0% (1/25) in the experimental group and 21.7% (5/23) in the control group, and the difference did not reach statistical significance (P = 0.08). The surgeon's subjective score was significantly higher in the experimental group than in the control group [5 (5,5) vs. 4 (4,4), P < 0.001]. No severe complications such as major vessel injury or direct optic nerve injury occurred in either group. CONCLUSION: Three-dimensional visualization preoperative planning based on 3D Slicer can significantly shorten the operative time of endoscopic endonasal optic nerve decompression, enhance the surgeon's confidence, and a potential reduction in cerebrospinal fluid leakage that warrants further investigation. This approach is low-cost, highly generalizable, and has good clinical application value.