• Cheng Jiang, Abhishek Bhattacharya, Joseph R Linzey, Rushikesh S Joshi, Sung Jik Cha, Sudharsan Srinivasan, Daniel Alber, Akhil Kondepudi, Esteban Urias, Balaji Pandian, Wajd N Al-Holou, Stephen E Sullivan, B Gregory Thompson, Jason A Heth, Christian W Freudiger, Siri Sahib S Khalsa, Donato R Pacione, John G Golfinos, Sandra Camelo-Piragua, Daniel A Orringer, Honglak Lee, and Todd C Hollon.
• Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, Michigan, USA.
• Neurosurgery. 2022 Jun 1; 90 (6): 758767758-767.

BackgroundAccurate specimen analysis of skull base tumors is essential for providing personalized surgical treatment strategies. Intraoperative specimen interpretation can be challenging because of the wide range of skull base pathologies and lack of intraoperative pathology resources.ObjectiveTo develop an independent and parallel intraoperative workflow that can provide rapid and accurate skull base tumor specimen analysis using label-free optical imaging and artificial intelligence.MethodsWe used a fiber laser-based, label-free, nonconsumptive, high-resolution microscopy method (<60 seconds per 1 × 1 mm2), called stimulated Raman histology (SRH), to image a consecutive, multicenter cohort of patients with skull base tumor. SRH images were then used to train a convolutional neural network model using 3 representation learning strategies: cross-entropy, self-supervised contrastive learning, and supervised contrastive learning. Our trained convolutional neural network models were tested on a held-out, multicenter SRH data set.ResultsSRH was able to image the diagnostic features of both benign and malignant skull base tumors. Of the 3 representation learning strategies, supervised contrastive learning most effectively learned the distinctive and diagnostic SRH image features for each of the skull base tumor types. In our multicenter testing set, cross-entropy achieved an overall diagnostic accuracy of 91.5%, self-supervised contrastive learning 83.9%, and supervised contrastive learning 96.6%. Our trained model was able to segment tumor-normal margins and detect regions of microscopic tumor infiltration in meningioma SRH images.ConclusionSRH with trained artificial intelligence models can provide rapid and accurate intraoperative analysis of skull base tumor specimens to inform surgical decision-making.Copyright © Congress of Neurological Surgeons 2022. All rights reserved.

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