Prediction of intraoperative cerebrospinal fluid leaks in endoscopic endonasal transsphenoidal pituitary surgery based on a deep neural network model trained with MRI images: a pilot study

Hui Chang; Kai Zhao; Jun Qiu; Xiang-Jun Ji; Wu-Gang Chen; Bo-Yuan Li; Cheng Lv; Zi-Cheng Xiong; Sheng-Bo Chen; Xu-Jun Shu

doi:10.3389/fnins.2023.1203698

Prediction of intraoperative cerebrospinal fluid leaks in endoscopic endonasal transsphenoidal pituitary surgery based on a deep neural network model trained with MRI images: a pilot study

Front Neurosci. 2023 Jul 27:17:1203698. doi: 10.3389/fnins.2023.1203698. eCollection 2023.

Authors

Hui Chang¹, Kai Zhao², Jun Qiu³, Xiang-Jun Ji⁴, Wu-Gang Chen¹, Bo-Yuan Li¹, Cheng Lv⁵, Zi-Cheng Xiong¹, Sheng-Bo Chen¹, Xu-Jun Shu⁴

Affiliations

¹ School of Computer and Information Engineering and Henan Engineering Research Center of Intelligent Technology and Application, Henan University, Kaifeng, Henan Province, China.
² The First Medical Center, Chinese PLA General Hospital, Beijing, China.
³ Department of Critical Care Medicine, The Second People's Hospital of Yibin, Yibin, Sichuan Province, China.
⁴ Department of Neurosurgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China.
⁵ School of Mathematics and Computer Sciences, Nanchang University, Nanchang, Jiangxi Province, China.

Abstract

Objective: This study aimed to investigate the reliability of a deep neural network (DNN) model trained only on contrast-enhanced T1 (T1CE) images for predicting intraoperative cerebrospinal fluid (ioCSF) leaks in endoscopic transsphenoidal surgery (EETS).

Methods: 396 pituitary adenoma (PA) cases were reviewed, only primary PAs with Hardy suprasellar Stages A, B, and C were included in this study. The T1CE images of these patients were collected, and sagittal and coronal T1CE slices were selected for training the DNN model. The model performance was evaluated and tested, and its interpretability was explored.

Results: A total of 102 PA cases were enrolled in this study, 51 from the ioCSF leakage group, and 51 from the non-ioCSF leakage group. 306 sagittal and 306 coronal T1CE slices were collected as the original dataset, and data augmentation was applied before model training and testing. In the test dataset, the DNN model provided a single-slice prediction accuracy of 97.29%, a sensitivity of 98.25%, and a specificity of 96.35%. In clinical test, the accuracy of the DNN model in predicting ioCSF leaks in patients reached 84.6%. The feature maps of the model were visualized and the regions of interest for prediction were the tumor roof and suprasellar region.

Conclusion: In this study, the DNN model could predict ioCSF leaks based on preoperative T1CE images, especially in PAs in Hardy Stages A, B, and C. The region of interest in the model prediction-making process is similar to that of humans. DNN models trained with preoperative MRI images may provide a novel tool for predicting ioCSF leak risk for PA patients.

Keywords: cerebrospinal fluid leaks; deep neural network model; endoscopic endonasal transsphenoidal surgery; neural network; pituitary adenoma.