{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T00:16:51Z","timestamp":1788308211451,"version":"build-2803163510"},"reference-count":34,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,1]]},"abstract":"\n OBJECTIVE<\/jats:title>\n Hyperspectral imaging (HSI) is an emerging intraoperative, noninvasive, contrast agent\u2013free imaging modality that enables quantitative assessment of tissue composition. The present study aimed to investigate whether HSI-derived tissue parameters correlate with WHO grade and molecular markers of aggressiveness in cranial meningiomas.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n \n In this prospective study, intraoperative in vivo HSI was performed using the TIVITA tissue system, capturing spectral signatures between 500 and 1000 nm. Quantitative tissue parameters included tissue oxygen saturation (StO\n 2<\/jats:sub>\n ), near-infrared perfusion index, organ hemoglobin index (OHI), and tissue water index (TWI). HSI parameters were correlated with histopathological WHO grade and molecular alterations, including\n CDKN2A\/B<\/jats:italic>\n deletion, TERT promoter mutation, and 1p\/22q loss. Group differences were analyzed using one-way ANOVA, and diagnostic performance was assessed using receiver operating characteristic (ROC) analysis.\n <\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n \n Forty-six meningiomas were included, comprising WHO grade 1 (n = 35) and WHO grade 2\u20133 (n = 11) tumors. TWI was significantly higher in WHO grade 2\u20133 meningiomas compared with WHO grade 1 tumors (mean 0.49 [SD 0.12] vs 0.38 [SD 0.17], p = 0.048). ROC analysis demonstrated an area under the ROC curve (AUC) of 0.71 (95% CI 0.56\u20130.86, p = 0.036) for TWI in discriminating higher-grade disease. A TWI cutoff \u2265 0.367 identified all WHO grade 2\u20133 meningiomas with 100% sensitivity and 100% negative predictive value. In a molecular subgroup (n = 15), OHI appeared higher in tumors with homozygous\n CDKN2A\/B<\/jats:italic>\n deletion than in nondeleted tumors (mean 0.77 [SD 0.04] vs 0.62 [SD 0.10]). However, only 3\n CDKN2A\/B<\/jats:italic>\n -deleted cases were available, and these findings should be considered descriptive. ROC analysis yielded an AUC of 0.89 (95% CI 0.71\u20131.00). An OHI cutoff \u2265 0.712 identified all three\n CDKN2A\/B<\/jats:italic>\n -deleted tumors (100% sensitivity), with 83.3% specificity and 86.7% accuracy.\n <\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n \n The present investigation demonstrated that HSI-derived tissue water and hemoglobin metrics provide biologically meaningful information in meningiomas. Low tissue water content appeared to rule out higher-grade diseases in this first subset cohort, while elevated hemoglobin showed a potential association with\n CDKN2A\/B<\/jats:italic>\n deletion in a small exploratory subgroup. These findings support the potential of HSI as a real-time noninvasive tool for intraoperative risk stratification and should be evaluated in large-scale studies.\n <\/jats:p>\n \n German Clinical Trials Register no. DRKS00036771 (\n www.drks.de<\/jats:ext-link>\n )\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2026.6.focus26183","type":"journal-article","created":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T00:01:34Z","timestamp":1787702494000},"page":"E15","source":"Crossref","is-referenced-by-count":0,"title":["Diagnostic performance of intraoperative in vivo hyperspectral imaging for meningioma grading and molecular alterations: results from a prospective feasibility study"],"prefix":"10.3171","volume":"61","author":[{"given":"Johannes","family":"Wach","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University Hospital Leipzig;"},{"name":"Comprehensive Cancer Center Central Germany, Partner Site Leipzig;"},{"name":"Innovation Center Computer Assisted Surgery (ICCAS), Faculty of Medicine, Leipzig University, Leipzig, Germany;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ferdinand","family":"Weber","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Hospital Leipzig;"},{"name":"Comprehensive Cancer Center Central Germany, Partner Site Leipzig;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annekatrin","family":"Pfahl","sequence":"additional","affiliation":[{"name":"Innovation Center Computer Assisted Surgery (ICCAS), Faculty of Medicine, Leipzig University, Leipzig, Germany;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannes","family":"K\u00f6hler","sequence":"additional","affiliation":[{"name":"Innovation Center Computer Assisted Surgery (ICCAS), Faculty of Medicine, Leipzig University, Leipzig, Germany;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Vychopen","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Hospital Leipzig;"},{"name":"Comprehensive Cancer Center Central Germany, Partner Site Leipzig;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Melzer","sequence":"additional","affiliation":[{"name":"Innovation Center Computer Assisted Surgery (ICCAS), Faculty of Medicine, Leipzig University, Leipzig, Germany;"},{"name":"Institute for Medical Science & Technology IMSaT, University of Dundee, United Kingdom; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alonso","family":"Barrantes-Freer","sequence":"additional","affiliation":[{"name":"Paul-Flechsig-Institute of Neuropathology, University Hospital Leipzig, Saxony, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erdem","family":"G\u00fcresir","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Hospital Leipzig;"},{"name":"Comprehensive Cancer Center Central Germany, Partner Site Leipzig;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"12 Suppl 2","key":"b1","series-title":"Neuro Oncol","first-page":"iv1","article-title":"CBTRUS statistical report: primary brain and other central nervous system tumors diagnosed in the United States in 2016\u20132020","volume":"25","author":"Ostrom QT","year":"2023","unstructured":"Ostrom QT, Price M, Neff C, CBTRUS statistical report: primary brain and other central nervous system tumors diagnosed in the United States in 2016\u20132020. 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J Neurosurg. 2024;140(2):393\u2013403. doi:10.3171\/2023.6.JNS23465"},{"issue":"11","key":"b4","series-title":"Neuro Oncol","first-page":"1821","article-title":"EANO guideline on the diagnosis and management of meningiomas","volume":"23","author":"Goldbrunner R","year":"2021","unstructured":"Goldbrunner R, Stavrinou P, Jenkinson MD, EANO guideline on the diagnosis and management of meningiomas. Neuro Oncol. 2021;23(11):1821\u20131834. doi:10.1093\/neuonc\/noab150"},{"issue":"1","key":"b5","series-title":"J Neurol Neurosurg Psychiatry","first-page":"22","article-title":"The recurrence of intracranial meningiomas after surgical treatment","volume":"20","author":"Simpson D","year":"1957","unstructured":"Simpson D. The recurrence of intracranial meningiomas after surgical treatment. J Neurol Neurosurg Psychiatry. 1957;20(1):22\u201339. doi:10.1136\/jnnp.20.1.22"},{"key":"b6","series-title":"World Neurosurg","first-page":"e331","article-title":"Prognostic factors and outcomes in World Health Organization Grade 1 and Grade 2 intracranial meningiomas-5-year institutional experience","volume":"187","author":"Nadeem M","year":"2024","unstructured":"Nadeem M, Goyal-Honavar A, Sravya P, Beniwal M, Santosh V, Dwarakanath S. Prognostic factors and outcomes in World Health Organization Grade 1 and Grade 2 intracranial meningiomas-5-year institutional experience. World Neurosurg. 2024;187:e331\u2013e339. doi:10.1016\/j.wneu.2024.04.082"},{"key":"b7","series-title":"World Neurosurg","first-page":"124646","article-title":"Progressing-free survival and prognostic factors with recurrence in 190 patients with primary atypical meningiomas","volume":"205","author":"Sun W","year":"2026","unstructured":"Sun W, Zhang Y, Wu X. 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Biomed Tech (Berl). 2018;63(5):547\u2013556. doi:10.1515\/bmt-2017-0155"},{"key":"b16","series-title":"Front Surg","first-page":"1477920","article-title":"Surgical Hyperspectral imaging and Indocyanine green Near-infrared Examination (SHINE) for brain arteriovenous malformation resection: a case report on how to visualize perfusion","volume":"11","author":"Wach J","year":"2024","unstructured":"Wach J, Weber F, Vychopen M, Surgical Hyperspectral imaging and Indocyanine green Near-infrared Examination (SHINE) for brain arteriovenous malformation resection: a case report on how to visualize perfusion. 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Nature. 2018;555(7697):469\u2013474. doi:10.1038\/nature26000"},{"issue":"3","key":"b20","series-title":"Acta Neuropathol","first-page":"409","article-title":"CDKN2A\/B homozygous deletion is associated with early recurrence in meningiomas","volume":"140","author":"Sievers P","year":"2020","unstructured":"Sievers P, Hielscher T, Schrimpf D, CDKN2A\/B homozygous deletion is associated with early recurrence in meningiomas. Acta Neuropathol. 2020;140(3):409\u2013413. doi:10.1007\/s00401-020-02188-w"},{"issue":"1","key":"b21","series-title":"Curr Protoc Mol Biol","first-page":"e59","article-title":"Overview of next generation sequencing technologies","volume":"122","author":"Slatko BE","year":"2018","unstructured":"Slatko BE, Gardner AF, Ausubel FM. Overview of next generation sequencing technologies. Curr Protoc Mol Biol. 2018;122(1):e59. doi:10.1002\/cpmb.59"},{"issue":"1","key":"b22","series-title":"Korean J Anesthesiol","first-page":"22","article-title":"Understanding one-way ANOVA using conceptual figures","volume":"70","author":"Kim TK","year":"2017","unstructured":"Kim TK. Understanding one-way ANOVA using conceptual figures. Korean J Anesthesiol. 2017;70(1):22\u201326. doi:10.4097\/kjae.2017.70.1.22"},{"issue":"1","key":"b23","series-title":"Korean J Anesthesiol","first-page":"25","article-title":"Receiver operating characteristic curve: overview and practical use for clinicians","volume":"75","author":"Nahm FS","year":"2022","unstructured":"Nahm FS. Receiver operating characteristic curve: overview and practical use for clinicians. Korean J Anesthesiol. 2022;75(1):25\u201336. doi:10.4097\/kja.21209"},{"issue":"3","key":"b24","series-title":"Biom J","first-page":"419","article-title":"Youden index and optimal cut-point estimated from observations affected by a lower limit of detection","volume":"50","author":"Ruopp MD","year":"2008","unstructured":"Ruopp MD, Perkins NJ, Whitcomb BW, Schisterman EF. Youden index and optimal cut-point estimated from observations affected by a lower limit of detection. Biom J. 2008;50(3):419\u2013430. doi:10.1002\/bimj.200710415"},{"issue":"1","key":"b25","series-title":"Sci Rep","first-page":"3829","article-title":"Challenges in, and recommendations for, hyperspectral imaging in ex vivo malignant glioma biopsy measurements","volume":"13","author":"Walke A","year":"2023","unstructured":"Walke A, Black D, Valdes PA, Stummer W, K\u00f6nig S, Suero-Molina E. Challenges in, and recommendations for, hyperspectral imaging in ex vivo malignant glioma biopsy measurements. Sci Rep. 2023;13(1):3829. doi:10.1038\/s41598-023-30680-2"},{"issue":"3","key":"b26","series-title":"Neurosurg Rev","first-page":"745","article-title":"Can MRI predict meningioma consistency? A correlation with tumor pathology and systematic review","volume":"41","author":"Yao A","year":"2018","unstructured":"Yao A, Pain M, Balchandani P, Shrivastava RK. Can MRI predict meningioma consistency? A correlation with tumor pathology and systematic review. Neurosurg Rev. 2018;41(3):745\u2013753. doi:10.1007\/s10143-016-0801-0"},{"issue":"1 Suppl 1","key":"b27","series-title":"Oper Neurosurg","first-page":"ONS108","article-title":"A surgical technique for the removal of clinoidal meningiomas","volume":"59","author":"Lee JH","year":"2006","unstructured":"Lee JH, Sade B, Park BJ. A surgical technique for the removal of clinoidal meningiomas. Oper Neurosurg. 2006;59(1 Suppl 1):ONS108\u2013ONS114. doi:10.1227\/01.NEU.0000220023.09021.03"},{"issue":"3","key":"b28","series-title":"Neurosurgery","first-page":"364","article-title":"Microsurgical removal of suprasellar meningiomas","volume":"16","author":"Al-Mefty O","year":"1985","unstructured":"Al-Mefty O, Holoubi A, Rifai A, Fox JL. Microsurgical removal of suprasellar meningiomas. Neurosurgery. 1985;16(3):364\u2013372. doi:10.1227\/00006123-198503000-00014"},{"issue":"1","key":"b29","series-title":"Acta Neuropathol Commun","first-page":"189","article-title":"Deletions are strongly associated with meningioma progression: a meta-analysis of individual patient data","volume":"11","author":"Wach J","year":"2023","unstructured":"Wach J, Basaran AE, Arlt F, Deletions are strongly associated with meningioma progression: a meta-analysis of individual patient data. 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