CNS-Obsidian: A Neurosurgical Vision-Language Model Built From Scientific Publications
Anton Alyakin, Jaden Stryker, Daniel Alexander Alber, Karl L. Sangwon, Jin Vivian Lee, Brandon Duderstadt, Akshay Save, David Kurland, Spencer Frome, Shrutika Singh, Jeff Zhang, Eunice Yang, Ki Yun Park, Cordelia Orillac, Aly A. Valliani, Sean Neifert, Albert Liu, Aneek Patel, Christopher Livia, Darryl Lau, Ilya Laufer, Peter A. Rozman, Eveline Teresa Hidalgo, Howard Riina, Rui Feng, Todd Hollon, Yindalon Aphinyanaphongs, John G. Golfinos, Laura Snyder, Eric Leuthardt, Douglas Kondziolka, Eric Karl Oermann
Published: 2025/2/26
Abstract
General-purpose vision-language models (VLMs) demonstrate impressive capabilities, but their opaque training on uncurated internet data posse critical limitations for high-stakes decision-making, such as in neurosurgery. We present CNS-Obsidian, a neurosurgical VLM trained on peer-reviewed neurosurgical literature, and demonstrate its clinical utility compared with GPT-4o in a real-world setting. We compiled 23,984 articles from Neurosurgery Publications journals, yielding 78,853 figures and captions. Using GPT-4o and Claude Sonnet-3.5, we converted these image-text pairs into 263,064 training samples across three formats: instruction fine-tuning, multiple-choice questions, and differential diagnosis. We trained CNS-Obsidian, a fine-tune of the 34-billion parameter LLaVA-Next model. In a blinded, randomized deployment trial at NYU Langone Health (Aug 30-Nov 30, 2024), neurosurgeons were assigned to use either CNS-Obsidian or GPT-4o as a diagnostic co-pilot after patient consultations. Primary outcomes were diagnostic helpfulness and accuracy. CNS-Obsidian matched GPT-4o on synthetic questions (76.13% vs 77.54%, p=0.235), but only achieved 46.81% accuracy on human-generated questions versus GPT-4o's 65.70% (p<10-15). In the randomized trial, 70 consultations were evaluated (32 CNS-Obsidian, 38 GPT-4o) from 959 total consults. CNS-Obsidian received positive ratings in 40.62% of cases versus 57.89% for GPT-4o (p=0.230). Both models included correct diagnosis in approximately 60% of cases (59.38% vs 65.79%, p=0.626). Domain-specific VLMs trained on curated scientific literature can approach frontier model performance in specialized medical domains despite being orders of magnitude smaller and less expensive to train. However, low clinical utilization suggests chatbot interfaces may not align with specialist workflows, indicating need for alternative AI integration strategies.