Optical technologies for intraoperative neurosurgical guidance

Abstract

Biomedical optics is a broadly interdisciplinary field at the interface of optical engineering, biophysics, computer science, medicine, biology, and chemistry, helping us understand light–tissue interactions to create applications with diagnostic and therapeutic value in medicine. Implementation of biomedical optics tools and principles has had a notable scientific and clinical resurgence in recent years in the neurosurgical community. This is in great part due to work in fluorescence-guided surgery of brain tumors leading to reports of significant improvement in maximizing the rates of gross-total resection. Multiple additional optical technologies have been implemented clinically, including diffuse reflectance spectroscopy and imaging, optical coherence tomography, Raman spectroscopy and imaging, and advanced quantitative methods, including quantitative fluorescence and lifetime imaging. Here we present a clinically relevant and technologically informed overview and discussion of some of the major clinical implementations of optical technologies as intraoperative guidance tools in neurosurgery.

Review of the potential of optical technologies for cancer diagnosis in neurosurgery: a step toward intraoperative neurophotonics

“…These changes can be specific to different tissue types and can provide measurable image contrast that provides information that can be complementary and even synergetic. 43 …”

“…The remitted light has some of its photons shifted to different wavelengths as by the addition or subtraction of vibrational energy from some of the tissue intramolecular bonds. 48 Contrast is achieved when the tissue molecular constituents differ enough that the Raman signals from two tissues have different wavelength distributions. Raman spectroscopy may be an ideal tool to intraoperatively delineate gray matter from white matter because it is minimally influenced by water content and can be performed in near-real time with sterile optical probes that a surgeon can apply to tissue in the operative field.…”

Optical coherence tomography for precision brain imaging, neurosurgical guidance and minimally invasive theranostics

“…Furthermore, many advanced technologies are widely used in intraoperative brain tumor detection and neurosurgical guidance, including computer tomography (CT) (13), diffusion-weighted magnetic resonance imaging (MRI) (14), fluorescence (15,16) and fluorescence spectral analysis (17), Raman spectroscope (18,19), ultrasound (20), photoacoustic imaging (21), biomarkers (22), and evaporative ionization mass spectrometry (23) etc. OCT can visualize sub-surface tissue structure non-invasively, the micro-meter depth microstructure of tissue also has an intuitive demonstration for neurosurgeons, and the research of neurosurgical OCT are launching gradually in neurosurgical diagnostics and guidance.…”

Fluorescence-guided resection of brain tumor: review of the significance of intraoperative quantification of protoporphyrin IX fluorescence

“…Over the past few years, several optical spectroscopy-based techniques including fluorescence imaging have been developed and tested to meet this need. 5,6 This review will highlight the usefulness and technical challenges in fluorescence-guided resection (FGR) or fluorescence-guided surgery (FGS) of brain tumor that utilizes protoporphyrin IX (PpIX).…”