Universitätsklinik Für Neurochirurgie, Otto-Von-Guericke-Universität Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Deutschland.
Neurosurg Rev. 2022 Feb;45(1):421-427. doi: 10.1007/s10143-021-01599-x. Epub 2021 Aug 16.
In light of our own experiences, we value the existing literature to critically point out possible "near" future applications of optical coherence tomography (OCT) as an intraoperative neurosurgical guidance tool. "Pub Med", "Cochrane Library", "Crossref Metadata Search", and "IEEE Xplore" databases as well as the search engine "Google Scholar" were screened for "optical coherence tomography + neurosurgery", "optical coherence tomography + intraoperative imaging + neurosurgery", and "microscope integrated optical coherence tomography + neurosurgery". n = 51 articles related to the use of OCT as an imaging technique in the field of neurosurgery or neurosurgical research. n = 7 articles documented the intraoperative use of OCT in patients. n = 4 articles documented the use of microscope-integrated optical coherence tomography as a neurosurgical guidance tool. The Results demonstrate that OCT is the first imaging technique to study microanatomy in vivo. Postoperative analysis of intraoperative scans holds promise to enrich our physiological and pathophysiological understanding of the human brain. No data exists to prove that OCT-guided surgery minimizes perioperative morbidity or extends tumor resection. But results suggest that regular use of microscope-integrated OCT could increase security during certain critical microsurgical steps like, e.g., dural dissection at cavernous sinus, transtentorial approaches, or aneurysm clip placement. Endoscopy integration could aid surgery in regions which are not yet accessible to real-time imaging modalities like the ventricles or hypophysis. Theranostic instruments which combine OCT with laser ablation might gain importance in the emerging field of minimal invasive tumor surgery. OCT depicts vessel wall layers and its pathologies uniquely. Doppler OCT could further visualize blood flow in parallel. These abilities shed light on promising future applications in the field of vascular neurosurgery.
基于我们的经验，我们重视现有文献，批判性地指出光学相干断层扫描（OCT）作为术中神经外科指导工具的可能“近期”应用。我们在“PubMed”、“Cochrane 图书馆”、“Crossref 元数据搜索”和“IEEE Xplore”数据库以及搜索引擎“Google Scholar”中搜索了“光学相干断层扫描+神经外科”、“光学相干断层扫描+术中成像+神经外科”和“显微镜集成光学相干断层扫描+神经外科”。共筛选出 51 篇与 OCT 在神经外科或神经外科研究领域作为成像技术的应用相关的文章。有 7 篇文章记录了 OCT 在患者中的术中应用。有 4 篇文章记录了显微镜集成光学相干断层扫描作为神经外科指导工具的应用。结果表明，OCT 是研究活体微解剖结构的第一种成像技术。术中扫描的术后分析有望丰富我们对人脑生理和病理生理学的理解。没有数据证明 OCT 引导手术可以降低围手术期发病率或扩大肿瘤切除范围。但结果表明，常规使用显微镜集成 OCT 可以在某些关键的显微手术步骤（如海绵窦硬脑膜切开术、经天幕入路或动脉瘤夹放置）中提高安全性。内窥镜集成可以帮助在脑室或垂体等还无法进行实时成像的区域进行手术。将 OCT 与激光消融相结合的治疗诊断仪器可能在微创肿瘤手术这一新兴领域变得越来越重要。OCT 独特地描绘了血管壁层及其病理。多普勒 OCT 可以进一步并行可视化血流。这些能力为血管神经外科领域的未来应用提供了希望。
