Confocal Neurolasermicroscopy in Human Brain – Perspectives for Neurosurgery on a Cellular Level (including additional Comments to this article)

Schlosser, Hans-Georg; Suess, Olaf; Vajkoczy, Peter; Landeghem, F. K. H. van; Zeitz, M.; Bojarski, Christian

doi:10.1055/s-0029-1237735

Cited by 22 publications

(13 citation statements)

References 22 publications

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“…These results reflect some of the aspects mentioned by other groups using confocal endomicroscopic techniques [10–12]. While the devices in use differ, examination of tumorous tissue provides images that allow a histological differentiation from healthy brain tissues.…”

Section: Resultssupporting

confidence: 82%

“…CLE is yet to be properly investigated in order to be fully integrated into standard neurosurgical procedures, but few groups are currently evaluating different devices as well as techniques, all of them benefiting from the knowledge of nonneurosurgical fields of application [10–12]. Further trials will see this device being used on different tumour entities to gather sufficient data for accurate intraoperative histological diagnosis.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Confocal Laser Endomicroscopy in Neurosurgery: A New Technique with Much Potential

Breuskin

DiVincenzo²,

Kim³

et al. 2013

Minimally Invasive Surgery

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Technical innovations in brain tumour diagnostic and therapy have led to significant improvements of patient outcome and recurrence free interval. The use of technical devices such as surgical microscopes as well as neuronavigational systems have helped localising tumours as much as fluorescent agents, such as 5-aminolaevulinic acid, have helped visualizing pathologically altered tissue. Nonetheless, intraoperative instantaneous frozen sections and histological diagnosis remain the only method of gaining certainty of the nature of the resected tissue. This technique is time consuming and does not provide close-to-real-time information. In gastroenterology, confocal endoscopy closed the gap between tissue resection and histological examination, providing an almost real-time histological diagnosis. The potential of this technique using a confocal laser endoscope EndoMAG1 by Karl Storz Company was evaluated by our group on pig brains, tumour tissue cell cultures, and fresh human tumour specimen. Here, the authors report for the first time on the results of applying this new technique and provide first confocal endoscopic images of various brain and tumour structures. In all, the technique harbours a very promising potential to provide almost real-time intraoperative diagnosis, but further studies are needed to provide evidence for the technique's potential.

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Section: Resultssupporting

confidence: 82%

Section: Resultsmentioning

confidence: 99%

Confocal Laser Endomicroscopy in Neurosurgery: A New Technique with Much Potential

Breuskin

DiVincenzo²,

Kim³

et al. 2013

Minimally Invasive Surgery

View full text Add to dashboard Cite

show abstract

“…15-19 Several methods are also being developed and tested to detect cases of low or variable tumor PpIX fluorescence signal, including intraoperative confocal microscopy 3,20-24 and intraoperative spectroscopy. 25-28 It is also unknown whether 5ALA detects clinically significant subsets of cancer cells such as cancer stem cells.…”

Section: Introductionmentioning

confidence: 99%

Fluorescent Cancer-Selective Alkylphosphocholine Analogs for Intraoperative Glioma Detection

et al. 2015

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Background 5-ALA induced tumor fluorescence aids brain tumor resections but is not approved for routine use in the United States. We developed and describe testing of two novel fluorescent, cancer-selective alkylphosphocholine analogs, CLR1501 (green) and CLR1502 (near-infrared), in a proof-of-principle study for fluorescence-guided glioma surgery. Objective To demonstrate CLR1501 and CLR1502 are cancer cell-selective fluorescence agents in glioblastoma models and compare tumor (T) to normal brain (N) fluorescence ratios with 5-ALA. Methods CLR1501, CLR1502, 5-ALA were administered to mice with MRI-verified orthotopic U251 GBM and GSC-derived xenografts. Harvested brains were imaged using confocal microscopy (CLR1501), IVIS Spectrum imaging system (CLR1501, CLR1502, and 5-ALA), or Fluobeam near-infrared fluorescence imaging system (CLR1502). Imaging and quantitative analysis of T:N fluorescence ratios were performed. Results Excitation/emission peaks are 500/517nm for CLR1501, and 760/778nm for CLR1502. The observed T:N ratio of CLR1502 (9.28±1.08) was significantly higher (p<0.01) than CLR1501 (3.51±0.44 on confocal imaging; 7.23±1.63 on IVIS imaging) and 5-ALA (4.81±0.92). Near-infrared Fluobeam CLR1502 imaging in a mouse xenograft model demonstrated high contrast tumor visualization compatible with surgical applications. Conclusion CLR1501 (green) and CLR1502 (near infrared) are novel tumor-selective fluorescent agents for discriminating tumor from normal brain. CLR1501 exhibits a tumor to brain fluorescence ratio similar to 5-ALA, whereas CLR1502 has a superior tumor to brain fluorescence ratio. This study demonstrates the potential use of CLR1501 and CLR1502 in fluorescence-guided tumor surgery.

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“…27,34,88,91,120,122,123,126,172 Schlosser et al provided the first report on confocal microscopy in neurosurgery. They examined intraoperatively ex vivo samples from 9 patients with GBM immediately following excision and reported the ability of this technology to identify features such as cell density, mitotic figures, necrosis, and microvascular proliferation.…”

Section: Fluorescencementioning

confidence: 99%

Optical technologies for intraoperative neurosurgical guidance

Valdés

Roberts

Lü³

et al. 2016

FOC

107

114

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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.

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Confocal Neurolasermicroscopy in Human Brain – Perspectives for Neurosurgery on a Cellular Level (including additional Comments to this article)

Cited by 22 publications

References 22 publications

Confocal Laser Endomicroscopy in Neurosurgery: A New Technique with Much Potential

Confocal Laser Endomicroscopy in Neurosurgery: A New Technique with Much Potential

Fluorescent Cancer-Selective Alkylphosphocholine Analogs for Intraoperative Glioma Detection

Optical technologies for intraoperative neurosurgical guidance

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