Development, Implementation and Application of Confocal Laser Endomicroscopy in Brain, Head and Neck Surgery—A Review

Abstract

When we talk about visualization methods in surgery, it is important to mention that the diagnosis of tumors and how we define tumor borders intraoperatively in a correct way are two main things that would not be possible to achieve without this grand variety of visualization methods we have at our disposal nowadays. In addition, histopathology also plays a very important role, and its importance cannot be neglected either. Some biopsy specimens, e.g., frozen sections, are examined by a histopathologist and lead to tumor diagnosis and the definition of its borders. Furthermore, surgical resection is a very important point when it comes to prognosis and life survival. Confocal laser endomicroscopy (CLE) is an imaging technique that provides microscopic information on the tissue in real time. CLE of disorders, such as head, neck and brain tumors, has only recently been suggested to contribute to both immediate tumor characterization and detection. It can be used as an additional tool for surgical biopsies during biopsy or surgical procedures and for inspection of resection margins during surgery. In this review, we analyze the development, implementation, advantages and disadvantages as well as the future directions of this technique in neurosurgical and otorhinolaryngological disciplines.

Lightfield hyperspectral imaging in neuro-oncology surgery: an IDEAL 0 and 1 study

“…In light of the above, there is an important research emphasis on advanced intra-operative tissue differentiation techniques. This can be either point based, e.g., Raman and reflectance spectroscopy (Vaqas et al, 2018 ), endomicroscopy (Kakaletri et al, 2022 ), or wide field, e.g., multispectral (MSI) or hyperspectral (HSI) imaging (Shapey et al, 2019 ). HSI in particular has already been shown to be a promising tool, demonstrating the capability to facilitate real-time wide-field label-free intra-operative tissue differentiation (Fabelo et al, 2018 , 2019 ; Shapey et al, 2019 ).…”

"Counting Neurons: Comparing Invasive and Noninvasive Techniques"

“…This can be done in brain slices or in whole brains that have been cleared using different techniques. Confocal microscopy is a technique that is often used in neuroscience research to visualize and count neurons in tissue sections [6][7][8]. It uses a laser light source to scan the sample and create high-resolution, 3D images of the tissue.…”