Technical Note: A Guide to Annotation of Neurosurgical Intraoperative Video for Machine Learning Analysis and Computer Vision

Dhiraj J. Pangal, Guillaume Kugener, Shane Shahrestani, Frank Attenello, Gabrial Zada, Daniel A. Donoho

In World Neurosurgery (2021).



Computer vision (CV) is a subset of artificial intelligence which performs computations on image or video data, permitting the quantitative analysis of visual information. Common CV tasks that may be relevant to surgeons include image classification, object detection and tracking, and extraction of higher order features. Despite the potential applications of CV to intraoperative video, however, few surgeons describe the use of CV. A primary roadblock in implementing CV is the lack of a clear workflow to create an intraoperative video dataset to which CV can be applied. We report general principles for creating usable surgical video datasets and the result of their applications.


Video annotations from cadaveric endoscopic endonasal skull base simulations (n=20 trials of 1-5 min, size = 8GB) were reviewed by 2 researcher-annotators. An internal, retrospective analysis of workflow for development of the intraoperative video annotations was performed to identify guiding practices.


Approximately 34,000 frames of surgical video were annotated. Key considerations in developing annotation workflows include: 1) Overcoming software and personnel constraints, 2) Ensuring adequate storage and access infrastructure 3) Optimization and standardization of annotation protocol, and 4) Operationalizing annotated data. Potential tools for use include CVAT and Vott: open-sourced annotation software allowing for local video storage, easy setup, and the use of interpolation.


CV techniques can be applied to surgical video, but challenges for novice users may limit adoption. We outline principles in annotation workflow that can mitigate initial challenges groups may have when converting raw video into useable, annotated datasets.