Intraoperative confocal microscopy for brain tumors: a feasibility analysis in humans.

Department

Neurosurgery; Neuropathology; Research

Document Type

Article

Abstract

BACKGROUND: The ability to diagnose brain tumors intraoperatively and identify tumor margins during resection could maximize resection and minimize morbidity. Advances in optical imaging enabled production of a handheld intraoperative confocal microscope.

OBJECTIVE: To present a feasibility analysis of the intraoperative confocal microscope for brain tumor resection.

METHODS: Thirty-three patients with brain tumor treated at Barrow Neurological Institute were examined. All patients received an intravenous bolus of sodium fluorescein before confocal imaging with the Optiscan FIVE 1 system probe. Optical biopsies were obtained within each tumor and along the tumor-brain interfaces. Corresponding pathologic specimens were then excised and processed. These data was compared by a neuropathologist to identify the concordance for tumor histology, grade, and margins.

RESULTS: Thirty-one of 33 lesions were tumors (93.9%) and 2 cases were identified as radiation necrosis (6.1%). Of the former, 25 (80.6%) were intra-axial and 6 (19.4%) were extra-axial. Intra-axial tumors were most commonly gliomas and metastases, while all extra-axial tumors were meningiomas. Among high-grade gliomas, vascular neoproliferation, as well as tumor margins, were identifiable using confocal imaging. Meningothelial and fibrous meningiomas were distinct on confocal microscopy--the latter featured spindle-shaped cells distinguishable from adjacent parenchyma. Other tumor histologies correlated well with standard neuropathology tissue preparations.

CONCLUSION: Intraoperative confocal microscopy is a practicable technology for the resection of human brain tumors. Preliminary analysis demonstrates reliability for a variety of lesions in identifying tumor cells and the tumor-brain interface. Further refinement of this technology depends upon the approval of tumor-specific fluorescent contrast agents for human use.

Medical Subject Headings

Adult; Aged; Biopsy; Brain Neoplasms; Feasibility Studies; Female; Glioma; Humans; Image Processing, Computer-Assisted; Intraoperative Period; Male; Meningeal Neoplasms; Meningioma; Microscopy, Confocal; Middle Aged; Neoplasm Grading; Neoplasm Metastasis

Publication Date

6-1-2011

Publication Title

Neurosurgery

ISSN

1524-4040

Volume

68

Issue

2 Suppl Operative

First Page

282

Last Page

290

PubMed ID

21336204

Digital Object Identifier (DOI)

10.1227/NEU.0b013e318212464e

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