Introduction Surgical success hinges on two core factors: technical execution and cognitive planning. While the former can be trained and potentially augmented through robotics, the latter — developing an accurate “mental roadmap” of a certain operation — remains complex, deeply individualized and resistant to standardization. In neurosurgery, where minute anatomical distinctions can dictate outcomes, enhancing intraoperative guidance could reduce variability among surgeons and improve global standards. Recent developments in machine vision offer a promising avenue. Previous studies demonstrated that deep learning models could successfully identify anatomical landmarks in highly standardized procedures such as trans-sphenoidal surgery (TSS). However, the applicability of such techniques in more variable and multidimensional intracranial procedures remains unproven. This study investigates whether a deep learning model can recognize key anatomical structures during the more complex pterional trans-sylvian (PTS) approach.

Materials and Methods We developed a deep learning object detection model (YOLOv7x) trained on 5.307 labeled frames from 78 surgical videos of 76 patients undergoing PTS. Surgical steps were standardized, and key anatomical targets—frontal/temporal dura, inferior frontal/superior temporal gyri, optic and olfactory nerves and internal carotid artery (ICA) — were annotated by specifically trained neurosurgical residents and verified by the operating surgeon. Bounding boxes derived from segmentation masks served as training inputs. Performance was evaluated using five-fold cross-validation.

Results The model achieved promising detection performance for deep structures, particularly the optic nerve (AP50: 0.73) and ICA (AP50: 0.67). Superficial structures, like the dura and the cortical gyri, had lower precision (AP50 range: 0.25–0.45), likely due to morphological similarity and optical variability. Performance variability across classes reflects the complexity of the anatomical setting along with data limitations.

Conclusion This study shows the feasibility of applying machine vision techniques for anatomical detection in a complex and variable neurosurgical setting. While challenges remain in detecting less distinctive structures, the high accuracy achieved for deep anatomical landmarks validates this approach. These findings mark an essential step towards a machine vision surgical guidance system. Future applications could include real-time anatomical recognition, integration with neuronavigation and the development of AI-supported “surgical roadmaps” to improve intraoperative orientation and global neurosurgical practice.

The authors have declared no competing interest.

This research is supported by SNF Project IZKSZ3_218786 research grant.

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Ethics committee of Cantonal Ethics Commission (KEK) of Zurich gave ethical approval for this work

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