gms | German Medical Science

65th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

11 - 14 May 2014, Dresden

Confocal laser endomicroscopy for real time histomorphological diagnosis: Our clinical experience with 150 brain and spinal tumor cases

Meeting Abstract

  • Patra Charalampaki - Department of Neurosurgery, Hospital Merheim, University of Witten-Herdecke, Cologne, Germany
  • Christian Eyth - Department of Neurosurgery, Hospital Merheim, University of Witten-Herdecke, Cologne, Germany
  • Mirwais Morgan - Department of Neurosurgery, Hospital Merheim, University of Witten-Herdecke, Cologne, Germany
  • Ioannis Pechlivanis - Department of Neurosurgery, Hospital Merheim, University of Witten-Herdecke, Cologne, Germany
  • Mehran Mahvash - Department of Neurosurgery, Hospital Merheim, University of Witten-Herdecke, Cologne, Germany
  • Alhadi Igressa - Department of Neurosurgery, Hospital Merheim, University of Witten-Herdecke, Cologne, Germany
  • Friedrich Weber - Department of Neurosurgery, Hospital Merheim, University of Witten-Herdecke, Cologne, Germany
  • Bernhard Schick - Department of Otorhinolaryngology, Saarland University Medical Center, Homburg/Saar, Germany

Deutsche Gesellschaft für Neurochirurgie. 65. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Dresden, 11.-14.05.2014. Düsseldorf: German Medical Science GMS Publishing House; 2014. DocMO.03.03

doi: 10.3205/14dgnc009, urn:nbn:de:0183-14dgnc0094

Published: May 13, 2014

© 2014 Charalampaki et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

Text

Objective: Confocal laser endomicroscopy (CLE) is a novel technique permitting in vivo histologic imaging with miniaturized endoscopic probes at excellent resolution. Goal was:

1.
to analyze the technical aspects of CLE technique,
2.
to investigate the integration of CLE in the neurosurgical daily workflow in the operation room,
3.
to create an easily integration of the CLE technique into the neurosurgical daily routine used endoscopic setting and providing immediate and intraoperativ histopathologic diagnosis of the entire entity on real time, and
4.
to evaluate CLE for in vivo diagnosis in different types and models of intracranial and intraspinal neoplasia.

Method: Fresh surgical biopsies of 150 intracranial and intraspinal lesions were examined to test the signal intensity and adequate contrast for CLE imaging after topical application of 0.1ml acriflavine. The lesions examined were different grades of glioma, meningiomas, craniopharyngiomas, different types of intrasellar lesions, acoustic neurinomas, spinal neurinomas, different brain metastasis, medulloblastomas, epidermoid tumors, spinal and in brain located ependymomas. Reproducible and specific histomorphologic criteria was the ex vivo histopathologic gold standard stainings according to our neuropathologists data.

Results: CLE equipment was easily integrated into the daily routine. We additionally combined the CLE equipment, with the microscopes and endoscopes in a picture in picture modus. The insertion of the CLE optical probe into the working channel of conventional brain endoscopes was easy to performed. CLE yielded high-quality histomorphology of brain and spinal tumors. CLE discrimination of neoplastic tissue was easy to perform based on tissue and cellular architecture. The resemblance with histopathology was excellent.

Conclusions: The implementation of CLE technique in neurosurgery could pose a new and important application for clinical routine and research. These findings might have impact on our future clinical approach to intracranial neoplasia and other forms of cancer. Confocal laser endomicroscopy allows immediate in vivo imaging of normal and neoplastic brain tissue at high resolution. It may become helpful to screen for tumor free margins not only for improving the real time histological definition of the tumor tissue, but also increasing the ability to accurate surgical resection of malignant brain tumors on a cellular level.