The technique of using three-dimensional and multiplanar reformatted computed tomography for preoperative planning in pediatric craniovertebral anomalies

•Surgical planning of pediatric craniovertebral anomalies is requires multiplanar CT reconstructions.•Screw trajectories can be planned in 4 steps using an open-source DICOM manipulation software.•This method gives more anatomical information compared to studying conventional PACS images. Computed tomography (CT) images provided by the radiology department may be inadequate for planning screws for rigid craniovertebral junction (CVJ) instrumentation. Although many recommend using multiplanar reconstruction (MPR) in line with screw trajectories, this is not always available to all surgeons. The current study aims to present a step-by-step workflow for preoperative planning for pediatric CVJ anomalies. Twenty-five consecutive children (