Intraoperative confocal microscopy for brain tumors: a feasibility analysis in humans.
Neurosurgery; Neuropathology; Research
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
2 Suppl Operative
Digital Object Identifier (DOI)
Sanai, Nader; Eschbacher, Jennifer M; Hattendorf, Guido; Coons, Stephen W; Preul, Mark C; Smith, Kris A; Nakaji, Peter; and Spetzler, Robert F, "Intraoperative confocal microscopy for brain tumors: a feasibility analysis in humans." (2011). Neurosurgery. 785.