Division of Neurological Surgery, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, Arizona 85013, USA.
Neurosurgery. 2010 Feb;66(2):410-7; discussion 417-8. doi: 10.1227/01.NEU.0000365772.66324.6F.
Recent developments in optical science and image processing have miniaturized the components required for confocal microscopy. Clinical confocal imaging applications have emerged, including assessment of colonic mucosal dysplasia during colonoscopy. We present our initial experience with handheld, miniaturized confocal imaging in a murine brain tumor model.
Twelve C57/BL6 mice were implanted intracranially with 10(5) GL261 glioblastoma cells. The brains of 6 anesthetized mice each at 14 and 21 days after implantation were exposed surgically, and the brain surface was imaged using a handheld confocal probe affixed to a stereotactic frame. The probe was moved systematically over regions of normal and tumor-containing tissue. Intravenous fluorescein and topical acriflavine contrast agents were used. Biopsies were obtained at each imaging site beneath the probe and assessed histologically. Mice were killed after imaging.
Handheld confocal imaging produced exquisite images, well-correlated with corresponding histologic sections, of cellular shape and tissue architecture in murine brain infiltrated by glial neoplasm. Reproducible patterns of cortical vasculature, as well as normal gray and white matter, were identified. Imaging effectively distinguished between tumor and nontumor tissue, including infiltrative tumor margins. Margins were easily identified by observers without prior neuropathology training after minimum experience with the technology.
Miniaturized handheld confocal imaging may assist neurosurgeons in detecting infiltrative brain tumor margins during surgery. It may help to avoid sampling error during biopsy of heterogeneous glial neoplasms, with the potential to supplement conventional intraoperative frozen section pathology. Clinical trials are warranted on the basis of these promising initial results.
光学科学和图像处理的最新发展使共聚焦显微镜所需的组件小型化。临床共聚焦成像应用已经出现，包括在结肠镜检查期间评估结肠黏膜发育不良。我们介绍了在鼠脑肿瘤模型中使用手持迷你共焦成像的初步经验。
12 只 C57/BL6 小鼠颅内植入 10(5) GL261 胶质母细胞瘤细胞。在植入后 14 天和 21 天，6 只麻醉小鼠的大脑暴露于手术中，并用固定在立体定向框架上的手持共焦探头对大脑表面进行成像。探头系统地移动到正常和包含肿瘤的组织区域。使用静脉内荧光素和局部吖啶橙对比剂。在探头下方的每个成像部位获得活检，并进行组织学评估。成像后处死小鼠。
手持共焦成像产生了精致的图像，与相应的组织学切片高度相关，显示了受神经胶质肿瘤浸润的鼠脑的细胞形状和组织结构。可识别重复性的皮质血管模式以及正常的灰质和白质。成像有效地将肿瘤和非肿瘤组织区分开来，包括浸润性肿瘤边缘。在使用该技术最少的经验后，没有神经病理学培训的观察者很容易通过该技术识别边缘。
小型化手持共焦成像可能有助于神经外科医生在手术中检测浸润性脑肿瘤边缘。它可以帮助避免对异质性神经胶质瘤进行活检时的取样误差，并有可能补充传统的术中冷冻切片病理学。基于这些有前途的初步结果，有必要进行临床试验。
