REVIEW  MINIMALLY INVASIVE AND MAXIMALLY EFFECTIVE NEUROSURGERY 

Journal of Neurosurgical Sciences 2018 December;62(6):704-17

DOI: 10.23736/S0390-5616.18.04553-8

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

Utilization of intraoperative confocal laser endomicroscopy in brain tumor surgery

Evgenii BELYKH ^{1, 2}, Claudio CAVALLO ¹, Sirin GANDHI ¹, Xiaochun ZHAO ¹, Damjan VELJANOSKI ¹, Mohammadhassan IZADY YAZDANABADI ¹, Nikolay L. MARTIROSYAN ¹, Vadim A. BYVALTSEV ², Jennifer ESCHBACHER ³, Mark C. PREUL ¹, Peter NAKAJI ¹ ✉

¹ Department of Neurosurgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA; ² Department of Neurosurgery, Irkutsk State Medical University, Irkutsk, Russia; ³ Department of Neuropathology, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA

Precise identification of tumor margins is of the utmost importance in neuro-oncology. Confocal microscopy is capable of rapid imaging of fresh tissues at cellular resolution and has been miniaturized into handheld probe-based systems suitable for use in the operating room. We aimed to perform a literature review to provide an update on the current status of confocal laser endomicroscopy (CLE) technology for brain tumor surgery. Aside from benchtop confocal microscopes used in ex vivo fashion, there are four CLE systems that have been investigated for potential application in the workflow of brain tumor surgery. Preclinical studies on animal tumor models and clinical studies on human brain tumors have assessed in vivo and ex vivo imaging approaches, suggesting that confocal microscopy holds promise for rapid identification of the characteristic (diagnostic) histological features of tumor and normal brain tissues. However, there are few studies assessing diagnostic accuracy sufficient to provide a definitive determination of the clinical and economical value of CLE in brain tumor surgery. Intraoperative real-time, high-resolution tissue imaging has significant clinical potential in the field of neuro-oncology. CLE is an emerging imaging technology that shows promise for improving brain tumor surgery workflow in in vivo and ex vivo studies. Future clinical studies are necessary to demonstrate clinical and economic benefit of CLE.

KEY WORDS: Microscopy, confocal - Brain neoplasms - Glioma - Neurosurgery