Intraoperative confocal microscopy for brain tumors: a feasibility analysis in humans.

Abstract

BACKGROUND:

The ability to diagnose brain tumors intraoperatively and identify tumor margins during resection could maximize resection and minimize morbidity. Advances in optical imaging enabled production of a handheld intraoperative confocal microscope.

OBJECTIVE:

To present a feasibility analysis of the intraoperative confocal microscope for brain tumor resection.

METHODS:

Thirty-three patients with brain tumor treated at Barrow Neurological Institute were examined. All patients received an intravenous bolus of sodium fluorescein before confocal imaging with the Optiscan FIVE 1 system probe. Optical biopsies were obtained within each tumor and along the tumor-brain interfaces. Corresponding pathologic specimens were then excised and processed. These data was compared by a neuropathologist to identify the concordance for tumor histology, grade, and margins.

RESULTS:

Thirty-one of 33 lesions were tumors (93.9%) and 2 cases were identified as radiation necrosis (6.1%). Of the former, 25 (80.6%) were intra-axial and 6 (19.4%) were extra-axial. Intra-axial tumors were most commonly gliomas and metastases, while all extra-axial tumors were meningiomas. Among high-grade gliomas, vascular neoproliferation, as well as tumor margins, were identifiable using confocal imaging. Meningothelial and fibrous meningiomas were distinct on confocal microscopy--the latter featured spindle-shaped cells distinguishable from adjacent parenchyma. Other tumor histologies correlated well with standard neuropathology tissue preparations.

CONCLUSION:

Intraoperative confocal microscopy is a practicable technology for the resection of human brain tumors. Preliminary analysis demonstrates reliability for a variety of lesions in identifying tumor cells and the tumor-brain interface. Further refinement of this technology depends upon the approval of tumor-specific fluorescent contrast agents for human use.

• Authors: Nader Sanai, Jennifer Eschbacher, Guido Hattendorf, Stephen W Coons, Mark C Preul, Kris A Smith, Peter Nakaji, Robert F Spetzler
• Journal: Neurosurgery (Neurosurgery) Vol. 68 Issue 2 Suppl Operative Pg. 282-90; discussion 290 (Jun 2011) ISSN: 1524-4040 [Electronic] United States
• PMID: 21336204 (Publication Type: Journal Article)

Topics

• Adult
• Aged
• Biopsy
• Brain Neoplasms (pathology, surgery)
• Feasibility Studies
• Female
• Glioma (pathology, surgery)
• Humans
• Image Processing, Computer-Assisted
• Intraoperative Period
• Male
• Meningeal Neoplasms (pathology, surgery)
• Meningioma (pathology, surgery)
• Microscopy, Confocal (methods)
• Middle Aged
• Neoplasm Grading
• Neoplasm Metastasis