Artikel
Evaluation of intraoperative confocal laser endomicroscopy in the resection of gliomas in comparison to the state of the art fluorescence-guided surgery
Verwertung der intraoperativen konfokalen Laser-Endomikroskopie im Vergleich zur Standard fluoreszenzgestützten Gliomchirurgie
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Autoren
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Patra Charalampaki
- Kliniken der Stadt Köln, Klinik für Neurochirurgie, Köln, Deutschland
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Samira Daali
- Kliniken der Stadt Köln, Klinik für Neurochirurgie, Köln, Deutschland
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Axel Heimann
- Universitätsmedizin Mainz, Institut für Neurochirurgische Pathophysiologie, Mainz, Deutschland
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Oliver Kempski
- Universitätsmedizin Mainz, Institut für Neurochirurgische Pathophysiologie, Mainz, Deutschland
| Veröffentlicht: | 8. Mai 2019 |
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Gliederung
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Objective: Confocal laser endomicroscopy (CLE) is a cutting-edge technology for real-time in vivo imaging of tissues at a cellular level. We tested the ability of CLE to identify the transition zones and infiltrative tumor cells in vivo in rat brains using the C6 glioma model. The aim was to achieve an extended resection of high-grade gliomas using two miniaturized confocal laser endomicroscopic systems (excitation wavelengths of 488nm and 780nm respectively) after staining tissues with four different fluorochromes.
Methods: Twenty seven rats with C6 gliomas underwent microsurgical resection. We stained the rats with four different agents acriflavine hydrochloride (topical), sodium fluorescein (intravenous), 5-aminolevulinic acid (oral), and indocyanine green (topical) with analog dosis known by human uses. A routine surgical fluorescence microscope with blue light filter (excitation 440nm) for detecting 5- aminolevulin acid served as the optical gold standard to perform the surgery and simulate same conditions as for human surgery.
Results: Best confocal imaging, between all agents was achieved after staining with indocyanine green, allowed a clear differentiation between tumor and healthy tissue in real-time and helped to achieve better surgical results compared with that of routine intraoperative fluorescence microscopy. To assess the applicability of this approach to human tissues, endomicroscopic ex vivo imaging of fresh human brain specimens of healthy and neoplastic tissues was performed after application of indocyanine green with satisfactory results in the correct identification of the biopsies (96,67%).
Conclusion: High-resolution CLE imaging allowed clear and easy distinction between neoplastic and healthy brain tissues when evaluated against traditional histology. Use of CLE-assisted surgery in surgical oncology would increase not only the initial diagnosis but also help to achieve complete tumor resection in the transition zone and prevent damage to normal tissues in the human brain.
