Confocal Laser Microscopy in Neurosurgery: State of the Art of Actual Clinical Applications

Abstract

Achievement of complete resections is of utmost importance in brain tumor surgery, due to the established correlation among extent of resection and postoperative survival. Various tools have recently been included in current clinical practice aiming to more complete resections, such as neuronavigation and fluorescent-aided techniques, histopathological analysis still remains the gold-standard for diagnosis, with frozen section as the most used, rapid and precise intraoperative histopathological method that permits an intraoperative differential diagnosis. Unfortunately, due to the various limitations linked to this technique, it is still unsatisfactorily for obtaining real-time intraoperative diagnosis. Confocal laser technology has been recently suggested as a promising method to obtain near real-time intraoperative histological data in neurosurgery, due to its established use in other non-neurosurgical fields. Still far to be widely implemented in current neurosurgical clinical practice, this technology was initially studied in preclinical experiences confirming its utility in identifying brain tumors, microvasculature and tumor margins. Hence, ex vivo and in vivo clinical studies evaluated the possibility with this technology of identifying and classifying brain neoplasms, discerning between normal and pathologic tissue, showing very promising results. This systematic review has the main objective of presenting a state-of-the-art summary on actual clinical applications of confocal laser imaging in neurosurgical practice.

Novel rapid intraoperative qualitative tumor detection by a residual convolutional neural network using label-free stimulated Raman scattering microscopy

“…It provides noninvasive real-time imaging. However, this technique is limited by the need for potential toxic fluorophores for contrast-enhancement and microstructure visualization [25]. Moreover, this technique requires intense user training and merely provides non-static gray scale confocal microscopic images [26][27][28], which is challenging imaging data to interpret even for trained neuropathologists.…”

Socio-Organizational Impact of Confocal Laser Endomicroscopy in Neurosurgery and Neuropathology: Results from a Process Analysis and Expert Survey

“…In this context, the lack of a reference catalogue has been mentioned. Particularly in the beginning, the interpretation of images can be challenging or imprecise, including the risk for misdiagnosis [12]. However, this is most likely only a temporary challenge.…”

“…This has been shown in several studies, both for in vivo and ex vivo analyses of animal and human brain tumor tissue [1,[8][9][10][11]. The authors of a recent systematic literature review, however, found the evidence-base to be insufficient to formulate a definite conclusion on the usefulness of CLE for intraoperative decision support [12]. Yet, several other medical fields such as gastroenterology [13,14], urology [15], and others [5,16,17] report promising results for the effective and safe use of CLE.…”

OCT-Guided Surgery for Gliomas: Current Concept and Future Perspectives

“…The main goal of using these methods is to detect tumor cells infiltration of brain tissue; also, they can be thought of as methods of OCT-based target biopsy during stereotactic procedures. The results of the current investigation show the perspectives of using confocal microscopy [98][99][100], Raman spectroscopy [101][102][103], fluorescence lifetime spectroscopy and imaging [104][105][106][107] and OCT [20,24,108]. Providing high-resolution imaging optical technologies may be regarded as substitution or, more likely, supplementation of traditional imaging such as MRI, ultrasound (US), 5-ALA or other fluorescence agents [96,97,109].…”