Department of Biomedical EngineeringUniversity of Kentucky Lexington KY 40506 USA.
Bioptics Technology LLC Lexington KY 40506 USA.
IEEE J Transl Eng Health Med. 2023 Dec 1;12:225-232. doi: 10.1109/JTEHM.2023.3338564. eCollection 2024.
Malignant glioma (MG) is the most common type of primary malignant brain tumors. Surgical resection of MG remains the cornerstone of therapy and the extent of resection correlates with patient survival. A limiting factor for resection, however, is the difficulty in differentiating the tumor from normal tissue during surgery. Fluorescence imaging is an emerging technique for real-time intraoperative visualization of MGs and their boundaries. However, most clinical grade neurosurgical operative microscopes with fluorescence imaging ability are hampered by low adoption rates due to high cost, limited portability, limited operation flexibility, and lack of skilled professionals with technical knowledge. To overcome the limitations, we innovatively integrated miniaturized light sources, flippable filters, and a recording camera to the surgical eye loupes to generate a wearable fluorescence eye loupe (FLoupe) device for intraoperative imaging of fluorescent MGs. Two FLoupe prototypes were constructed for imaging of Fluorescein and 5-aminolevulinic acid (5-ALA), respectively. The wearable FLoupe devices were tested on tumor-simulating phantoms and patients with MGs. Comparable results were observed against the standard neurosurgical operative microscope (PENTERO® 900) with fluorescence kits. The affordable and wearable FLoupe devices enable visualization of both color and fluorescence images with the same quality as the large and expensive stationary operative microscopes. The wearable FLoupe device allows for a greater range of movement, less obstruction, and faster/easier operation. Thus, it reduces surgery time and is more easily adapted to the surgical environment than unwieldy neurosurgical operative microscopes. Clinical and Translational Impact Statement-The affordable and wearable fluorescence imaging device developed in this study enables neurosurgeons to observe brain tumors with the same clarity and greater flexibility compared to bulky and costly operative microscopes.
恶性胶质瘤（MG）是最常见的原发性恶性脑肿瘤。MG 的手术切除仍然是治疗的基石，切除范围与患者的生存相关。然而，切除的一个限制因素是在手术中难以将肿瘤与正常组织区分开来。荧光成像是一种用于实时术中可视化 MG 及其边界的新兴技术。然而，大多数具有荧光成像能力的临床级神经外科手术显微镜由于成本高、便携性有限、操作灵活性有限以及缺乏具有技术知识的熟练专业人员，采用率较低。为了克服这些限制，我们创新性地将微型光源、可翻转滤光片和记录相机集成到手术目镜上，以生成用于术中荧光 MG 成像的可穿戴荧光目镜（FLoupe）设备。分别构建了两个用于荧光素和 5-氨基酮戊酸（5-ALA）成像的 FLoupe 原型。在肿瘤模拟体和 MG 患者上测试了可穿戴的 FLoupe 设备。与带有荧光套件的标准神经外科手术显微镜（PENTERO®900）相比，观察到可比的结果。负担得起且可穿戴的 FLoupe 设备能够以与大型昂贵的固定式手术显微镜相同的质量可视化彩色和荧光图像。可穿戴的 FLoupe 设备允许更大的运动范围、更少的阻碍以及更快/更容易的操作。因此，与笨拙的神经外科手术显微镜相比，它可以减少手术时间并且更容易适应手术环境。临床和转化影响声明-本研究开发的负担得起且可穿戴的荧光成像设备使神经外科医生能够观察到与笨重且昂贵的手术显微镜相比具有相同清晰度和更大灵活性的脑肿瘤。
