• Sami Puustinen, Hana Vrzáková, Joni Hyttinen, Tuomas Rauramaa, Pauli Fält, Markku Hauta-Kasari, Roman Bednarik, Timo Koivisto, Susanna Rantala, Mikael von Und Zu Fraunberg, Juha E Jääskeläinen, and Antti-Pekka Elomaa.
• University of Eastern Finland, Faculty of Health Sciences, School of Medicine, Kuopio, Finland; Kuopio University Hospital, Eastern Finland Microsurgery Center, Kuopio, Finland. Electronic address: sampuu@uef.fi.
• World Neurosurg. 2023 Jul 1; 175: e614e635e614-e635.

BackgroundHyperspectral imaging (HSI) has the potential to enhance surgical tissue detection and diagnostics. Definite utilization of intraoperative HSI guidance demands validated machine learning and public datasets that currently do not exist. Moreover, current imaging conventions are dispersed, and evidence-based paradigms for neurosurgical HSI have not been declared.MethodsWe presented the rationale and a detailed clinical paradigm for establishing microneurosurgical HSI guidance. In addition, a systematic literature review was conducted to summarize the current indications and performance of neurosurgical HSI systems, with an emphasis on machine learning-based methods.ResultsThe published data comprised a few case series or case reports aiming to classify tissues during glioma operations. For a multitissue classification problem, the highest overall accuracy of 80% was obtained using deep learning. Our HSI system was capable of intraoperative data acquisition and visualization with minimal disturbance to glioma surgery.ConclusionsIn a limited number of publications, neurosurgical HSI has demonstrated unique capabilities in contrast to the established imaging techniques. Multidisciplinary work is required to establish communicable HSI standards and clinical impact. Our HSI paradigm endorses systematic intraoperative HSI data collection, which aims to facilitate the related standards, medical device regulations, and value-based medical imaging systems.Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.

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