2025 Poster Presentations
P449: HYPERSPECTRAL IMAGING FACILITATES EARLY DETECTION OF INTRA-OPERATIVE ISCHAEMIA DURING NEUROVASCULAR SURGERY
Oscar J MacCormac1; Conor C Horgan2; Zhonghao Wang1; Matthew Elliot1; Dale Waterhouse2; Sebastien Ourselin1; Michael Ebner2; Christos Tolias3; Ahilan Kailaya-Vasan3; Tom Vercauteren1; Jonathan Shapey1; 1King's College London; 2Hypervision Surgical Ltd.; 3King's College Hospitals NHS Foundation Trust
Background: Hyperspectral imaging (HSI) is an advanced, wide field optical imaging technique that enables the detection of light reflectance as multiple, narrow wavelength bands as opposed to the conventional three red, green and blue (RGB) broad wavelength bands seen with the naked eye. When applied to biological tissue, the refined spectral information from HSI permits real-time extraction of biological and physiological parameters, one of which is tissue oxygenation (StO2). Intra-operative stroke occurs in up to 6.4% of cranial neurosurgical procedures, and thus early detection of intra-operative ischaemia may prove key to improving patient outcomes. Here we describe a case series in which a novel HSI system has been deployed in neurovascular surgery, demonstrating real-time change in StO2.
Methods: A snapshot mosaic HSI camera was coupled to a Zeiss Kinevo-900 (Fig 1) and connected to a dedicated camera control unit. Using software developed by Hypervision Surgical Ltd, real-time HSI video recordings were acquired during eight aneurysm surgeries and eight arteriovenous malformation (AVM) extirpations. From these recordings, spectral tissue information, including StO2, was extracted from surgeon annotated regions of interest (RoI). The operating room team completed questionnaires designed based on the System Engineering Initiative for Patient Safety (SEIPS) framework, along with semi-structured interviews after each case to assess how well the HSI system integrates into the neurosurgical theatre workflow.
Results: Using our system, real-time HSI recordings were successfully and safely acquired during all 16 cases. In one middle cerebral artery (MCA) aneurysm clipping, our HSI detected a decrease in StO2 over a region of cortex 8 minutes before electrophysiological change was demonstrated. In a second procedure, a resection of a giant, distal posterior inferior cerebellar artery (PICA) aneurysm (Fig 2) and anastomosis, our system detected ischaemia within the medulla (Fig 3) and clear reperfusion once flow was re-established (Fig 4). Feedback from all operating room team members was positive, demonstrating minimal disruption to the standard neurosurgical workflow.
Conclusions: Our intra-operative HSI system integrated seamlessly into the neurosurgical workflow whilst demonstrating the capability to provide enhanced tissue information to the surgeon in real-time. Not only did tissue oxygenation correlate with electrophysiological changes, but it also demonstrated ischaemia before these changes were detected, paving the way for earlier intra-operative surgical decision making and safer surgery in the future.
