Florida Department of General Surgery, Cleveland Clnic Florida, 2950 Cleveland Clinic Boulevard, Weston, FL, 33331, USA.
Instituto Argentino de Diagnóstico y Tratamiento Buenos Aires Argentina, Av. Córdoba 2351, C1121ABJ CABA, Buenos Aires, Argentina.
Surg Endosc. 2022 Jun;36(6):4079-4089. doi: 10.1007/s00464-021-08729-y. Epub 2021 Oct 25.
Nerve visualization and the identification of other neural tissues during surgery is crucial for numerous reasons, including the prevention of iatrogenic nerve and neural structure injury and facilitation of nerve repair. However, current methods of intra-operative nerve detection are generally expensive, unproven, and/or technically challenging. Recently, we have documented, in both in vivo animal models and ex vivo human tissue, that nerves autofluorescence when viewed in near-ultraviolet light (NUV). In this paper, we describe our use of nerve autofluorescence to facilitate the visualization of nerves and other neural tissues intra-operatively in 17 patients undergoing a range of surgical procedures.
Employing the same prototype axon imaging system previously documented to markedly enhance nerve visualization in both in vivo animal and ex vivo human models, surgical fields were observed in 17 patients under both white and NUV light during parotid tumor resection (n = 3), thyroid tumor resection (n = 7), and surgery for peripheral nerve and spinal tumors and injury (n = 7).
In all 17 patients, the intra-operative use of the imaging system both was feasible and markedly enhanced the localization of all neural tissues throughout their course within the surgical field. All 17 procedures were successful and devoid of any peri-operative complications or post-operative neurological deficits.
Intra-operatively visualizing auto-fluorescent peripheral nerves and other neural tissues under NUV light is feasible in human patients across a range of clinical scenarios and appears to appreciably enhance nerve and other neural tissue visualization. Controlled studies to explore this technology further are needed.
在手术过程中，可视化神经和识别其他神经组织至关重要，原因有很多，包括预防医源性神经和神经结构损伤，以及便于神经修复。然而，目前术中神经检测的方法通常价格昂贵、未经证实且/或具有技术挑战性。最近，我们在体内动物模型和离体人体组织中都记录到，在近紫外光（NUV）下观察时，神经会自发荧光。在本文中，我们描述了我们使用神经自发荧光术在 17 名接受各种手术的患者中辅助术中可视化神经和其他神经组织的应用。
我们使用先前在体内动物和离体人体模型中均显著增强神经可视化效果的相同原型轴突成像系统，在 17 名接受腮腺肿瘤切除术（n=3）、甲状腺肿瘤切除术（n=7）以及周围神经和脊髓肿瘤和损伤手术（n=7）的患者中，在手术野下分别观察白光和 NUV 光下的手术野。
在所有 17 名患者中，该成像系统的术中应用既可行又显著增强了手术野中所有神经组织的定位。17 项手术均成功，且无任何围手术期并发症或术后神经功能缺损。
在人体患者中，在 NUV 光下可视化自发荧光的周围神经和其他神经组织是可行的，并且似乎明显增强了神经和其他神经组织的可视化效果。需要进一步进行对照研究来探索这项技术。
