Intraoperative Probe-Based Confocal Laser Endomicroscopy in Surgery and Stereotactic Biopsy of Low-Grade and High-Grade Gliomas: A Feasibility Study in Humans
BACKGROUND:The management of gliomas is based on precise histologic diagnosis. The tumor tissue can be obtained during open surgery or via stereotactic biopsy. Intraoperative tissue imaging could substantially improve biopsy precision and, ultimately, the extent of resection. OBJECTIVE:To show the f...
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| Veröffentlicht in: | Neurosurgery 2016-10, Vol.79 (4), p.604-612 |
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| creator | Pavlov, Vladislav Meyronet, David Meyer-Bisch, Vincent Armoiry, Xavier Pikul, Brian Dumot, Chloé Beuriat, Pierre-Aurelien Signorelli, Francesco Guyotat, Jacques |
| description | BACKGROUND:The management of gliomas is based on precise histologic diagnosis. The tumor tissue can be obtained during open surgery or via stereotactic biopsy. Intraoperative tissue imaging could substantially improve biopsy precision and, ultimately, the extent of resection.
OBJECTIVE:To show the feasibility of intraoperative in vivo probe-based confocal laser endomicroscopy (pCLE) in surgery and biopsy of gliomas.
METHODS:In our prospective observational study, 9 adult patients were enrolled between September 2014 and January 2015. Two contrast agents were used5-aminolevulinic acid (3 cases) or intravenous fluorescein (6 cases). Intraoperative imaging was performed with the Cellvizio system (Mauna Kea Technologies, Paris). A 0.85-mm probe was used for stereotactic procedures, with the biopsy needle modified to have a distal opening. During open brain surgery, a 2.36-mm probe was used. Each series corresponds to a separate histologic fragment.
RESULTS:The diagnoses of the lesions were glioblastoma (4 cases), low-grade glioma (2), grade III oligoastrocytoma (2), and lymphoma (1). Autofluorescence of neurons in cortex was observed. Cellvizio images enabled differentiation of healthy “normal” tissue from pathological tissue in open surgery and stereotactic biopsy using fluorescein. 5-Aminolevulinic acid confocal patterns were difficult to establish. No intraoperative complications related to pCLE or to use of either contrast agent were observed.
CONCLUSION:We report the initial feasibility and safety of intraoperative pCLE during primary brain tumor resection and stereotactic biopsy procedures. Pending further investigation, pCLE of brain tissue could be utilized for intraoperative surgical guidance, improvement in brain biopsy yield, and optimization of glioma resection via analysis of tumor margins.
ABBREVIATIONS:5-ALA, 5-aminolevulinic acidpCLE, probe-based confocal laser endomicroscopyPpIX, protoporphyrin IX |
| doi_str_mv | 10.1227/NEU.0000000000001365 |
| format | Article |
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OBJECTIVE:To show the feasibility of intraoperative in vivo probe-based confocal laser endomicroscopy (pCLE) in surgery and biopsy of gliomas.
METHODS:In our prospective observational study, 9 adult patients were enrolled between September 2014 and January 2015. Two contrast agents were used5-aminolevulinic acid (3 cases) or intravenous fluorescein (6 cases). Intraoperative imaging was performed with the Cellvizio system (Mauna Kea Technologies, Paris). A 0.85-mm probe was used for stereotactic procedures, with the biopsy needle modified to have a distal opening. During open brain surgery, a 2.36-mm probe was used. Each series corresponds to a separate histologic fragment.
RESULTS:The diagnoses of the lesions were glioblastoma (4 cases), low-grade glioma (2), grade III oligoastrocytoma (2), and lymphoma (1). Autofluorescence of neurons in cortex was observed. Cellvizio images enabled differentiation of healthy “normal” tissue from pathological tissue in open surgery and stereotactic biopsy using fluorescein. 5-Aminolevulinic acid confocal patterns were difficult to establish. No intraoperative complications related to pCLE or to use of either contrast agent were observed.
CONCLUSION:We report the initial feasibility and safety of intraoperative pCLE during primary brain tumor resection and stereotactic biopsy procedures. Pending further investigation, pCLE of brain tissue could be utilized for intraoperative surgical guidance, improvement in brain biopsy yield, and optimization of glioma resection via analysis of tumor margins.
ABBREVIATIONS:5-ALA, 5-aminolevulinic acidpCLE, probe-based confocal laser endomicroscopyPpIX, protoporphyrin IX</description><identifier>ISSN: 0148-396X</identifier><identifier>EISSN: 1524-4040</identifier><identifier>DOI: 10.1227/NEU.0000000000001365</identifier><identifier>PMID: 27643918</identifier><language>eng</language><publisher>United States: Copyright by the Congress of Neurological Surgeons</publisher><subject>Adult ; Aged ; Biopsy ; Biopsy, Needle ; Brain cancer ; Brain Neoplasms - diagnosis ; Brain Neoplasms - surgery ; Contrast Media ; Feasibility Studies ; Female ; Glioma ; Glioma - diagnosis ; Glioma - surgery ; Humans ; Intraoperative Period ; Male ; Microscopy, Confocal - methods ; Middle Aged ; Prospective Studies ; Stereotaxic Techniques ; Surgery</subject><ispartof>Neurosurgery, 2016-10, Vol.79 (4), p.604-612</ispartof><rights>Copyright © by the Congress of Neurological Surgeons</rights><rights>Copyright © Congress of Neurological Surgeons</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3845-b8969c5be3348cf46713ed9a4f058de586ebbdddc6c414aa1073c189aa2632c13</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27903,27904</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27643918$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Pavlov, Vladislav</creatorcontrib><creatorcontrib>Meyronet, David</creatorcontrib><creatorcontrib>Meyer-Bisch, Vincent</creatorcontrib><creatorcontrib>Armoiry, Xavier</creatorcontrib><creatorcontrib>Pikul, Brian</creatorcontrib><creatorcontrib>Dumot, Chloé</creatorcontrib><creatorcontrib>Beuriat, Pierre-Aurelien</creatorcontrib><creatorcontrib>Signorelli, Francesco</creatorcontrib><creatorcontrib>Guyotat, Jacques</creatorcontrib><title>Intraoperative Probe-Based Confocal Laser Endomicroscopy in Surgery and Stereotactic Biopsy of Low-Grade and High-Grade Gliomas: A Feasibility Study in Humans</title><title>Neurosurgery</title><addtitle>Neurosurgery</addtitle><description>BACKGROUND:The management of gliomas is based on precise histologic diagnosis. The tumor tissue can be obtained during open surgery or via stereotactic biopsy. Intraoperative tissue imaging could substantially improve biopsy precision and, ultimately, the extent of resection.
OBJECTIVE:To show the feasibility of intraoperative in vivo probe-based confocal laser endomicroscopy (pCLE) in surgery and biopsy of gliomas.
METHODS:In our prospective observational study, 9 adult patients were enrolled between September 2014 and January 2015. Two contrast agents were used5-aminolevulinic acid (3 cases) or intravenous fluorescein (6 cases). Intraoperative imaging was performed with the Cellvizio system (Mauna Kea Technologies, Paris). A 0.85-mm probe was used for stereotactic procedures, with the biopsy needle modified to have a distal opening. During open brain surgery, a 2.36-mm probe was used. Each series corresponds to a separate histologic fragment.
RESULTS:The diagnoses of the lesions were glioblastoma (4 cases), low-grade glioma (2), grade III oligoastrocytoma (2), and lymphoma (1). Autofluorescence of neurons in cortex was observed. Cellvizio images enabled differentiation of healthy “normal” tissue from pathological tissue in open surgery and stereotactic biopsy using fluorescein. 5-Aminolevulinic acid confocal patterns were difficult to establish. No intraoperative complications related to pCLE or to use of either contrast agent were observed.
CONCLUSION:We report the initial feasibility and safety of intraoperative pCLE during primary brain tumor resection and stereotactic biopsy procedures. Pending further investigation, pCLE of brain tissue could be utilized for intraoperative surgical guidance, improvement in brain biopsy yield, and optimization of glioma resection via analysis of tumor margins.
ABBREVIATIONS:5-ALA, 5-aminolevulinic acidpCLE, probe-based confocal laser endomicroscopyPpIX, protoporphyrin IX</description><subject>Adult</subject><subject>Aged</subject><subject>Biopsy</subject><subject>Biopsy, Needle</subject><subject>Brain cancer</subject><subject>Brain Neoplasms - diagnosis</subject><subject>Brain Neoplasms - surgery</subject><subject>Contrast Media</subject><subject>Feasibility Studies</subject><subject>Female</subject><subject>Glioma</subject><subject>Glioma - diagnosis</subject><subject>Glioma - surgery</subject><subject>Humans</subject><subject>Intraoperative Period</subject><subject>Male</subject><subject>Microscopy, Confocal - methods</subject><subject>Middle Aged</subject><subject>Prospective Studies</subject><subject>Stereotaxic Techniques</subject><subject>Surgery</subject><issn>0148-396X</issn><issn>1524-4040</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp9kcFu1DAQhi0EokvhDRCyxIVLShw7jsOtXW13K60AqVTiFk3sSdcliVM7YZWX4VlxuwtCPeCLNdI3n0b_T8hblp6xLCs-fl7dnKX_PMZl_owsWJ6JRKQifU4WKRMq4aX8fkJehXAXGSkK9ZKcZIUUvGRqQX5d9aMHN6CH0f5E-tW7GpMLCGjo0vWN09DSbRw9XfXGdVZ7F7QbZmp7ej35W_Qzhd7Q6xE9uhH0aDW9sG4IM3UN3bp9svZg8BHa2NvdcVy31nUQPtFzeokQbG1bO85RM5lH92bqoA-vyYsG2oBvjv8publcfVtuku2X9dXyfJtorkSe1KqUpc5r5Fwo3QhZMI6mBNGkuTKYK4l1bYzRUgsmAFhacM1UCZBJnmnGT8mHg3fw7n7CMFadDRrbFnp0U6iYyjKWxZSLiL5_gt65yffxuorFK0pZ5EpFShyoh7yCx6YavO3AzxVLq4f-qthf9bS_uPbuKJ_qDs3fpT-FRUAdgL1rY-LhRzvt0Vc7hHbc_d_9G7jGp-0</recordid><startdate>201610</startdate><enddate>201610</enddate><creator>Pavlov, Vladislav</creator><creator>Meyronet, David</creator><creator>Meyer-Bisch, Vincent</creator><creator>Armoiry, Xavier</creator><creator>Pikul, Brian</creator><creator>Dumot, Chloé</creator><creator>Beuriat, Pierre-Aurelien</creator><creator>Signorelli, Francesco</creator><creator>Guyotat, Jacques</creator><general>Copyright by the Congress of Neurological Surgeons</general><general>Wolters Kluwer Health, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>201610</creationdate><title>Intraoperative Probe-Based Confocal Laser Endomicroscopy in Surgery and Stereotactic Biopsy of Low-Grade and High-Grade Gliomas: A Feasibility Study in Humans</title><author>Pavlov, Vladislav ; Meyronet, David ; Meyer-Bisch, Vincent ; Armoiry, Xavier ; Pikul, Brian ; Dumot, Chloé ; Beuriat, Pierre-Aurelien ; Signorelli, Francesco ; Guyotat, Jacques</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3845-b8969c5be3348cf46713ed9a4f058de586ebbdddc6c414aa1073c189aa2632c13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Biopsy</topic><topic>Biopsy, Needle</topic><topic>Brain cancer</topic><topic>Brain Neoplasms - diagnosis</topic><topic>Brain Neoplasms - surgery</topic><topic>Contrast Media</topic><topic>Feasibility Studies</topic><topic>Female</topic><topic>Glioma</topic><topic>Glioma - diagnosis</topic><topic>Glioma - surgery</topic><topic>Humans</topic><topic>Intraoperative Period</topic><topic>Male</topic><topic>Microscopy, Confocal - methods</topic><topic>Middle Aged</topic><topic>Prospective Studies</topic><topic>Stereotaxic Techniques</topic><topic>Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Pavlov, Vladislav</creatorcontrib><creatorcontrib>Meyronet, David</creatorcontrib><creatorcontrib>Meyer-Bisch, Vincent</creatorcontrib><creatorcontrib>Armoiry, Xavier</creatorcontrib><creatorcontrib>Pikul, Brian</creatorcontrib><creatorcontrib>Dumot, Chloé</creatorcontrib><creatorcontrib>Beuriat, Pierre-Aurelien</creatorcontrib><creatorcontrib>Signorelli, Francesco</creatorcontrib><creatorcontrib>Guyotat, Jacques</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Neurosurgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Pavlov, Vladislav</au><au>Meyronet, David</au><au>Meyer-Bisch, Vincent</au><au>Armoiry, Xavier</au><au>Pikul, Brian</au><au>Dumot, Chloé</au><au>Beuriat, Pierre-Aurelien</au><au>Signorelli, Francesco</au><au>Guyotat, Jacques</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Intraoperative Probe-Based Confocal Laser Endomicroscopy in Surgery and Stereotactic Biopsy of Low-Grade and High-Grade Gliomas: A Feasibility Study in Humans</atitle><jtitle>Neurosurgery</jtitle><addtitle>Neurosurgery</addtitle><date>2016-10</date><risdate>2016</risdate><volume>79</volume><issue>4</issue><spage>604</spage><epage>612</epage><pages>604-612</pages><issn>0148-396X</issn><eissn>1524-4040</eissn><abstract>BACKGROUND:The management of gliomas is based on precise histologic diagnosis. The tumor tissue can be obtained during open surgery or via stereotactic biopsy. Intraoperative tissue imaging could substantially improve biopsy precision and, ultimately, the extent of resection.
OBJECTIVE:To show the feasibility of intraoperative in vivo probe-based confocal laser endomicroscopy (pCLE) in surgery and biopsy of gliomas.
METHODS:In our prospective observational study, 9 adult patients were enrolled between September 2014 and January 2015. Two contrast agents were used5-aminolevulinic acid (3 cases) or intravenous fluorescein (6 cases). Intraoperative imaging was performed with the Cellvizio system (Mauna Kea Technologies, Paris). A 0.85-mm probe was used for stereotactic procedures, with the biopsy needle modified to have a distal opening. During open brain surgery, a 2.36-mm probe was used. Each series corresponds to a separate histologic fragment.
RESULTS:The diagnoses of the lesions were glioblastoma (4 cases), low-grade glioma (2), grade III oligoastrocytoma (2), and lymphoma (1). Autofluorescence of neurons in cortex was observed. Cellvizio images enabled differentiation of healthy “normal” tissue from pathological tissue in open surgery and stereotactic biopsy using fluorescein. 5-Aminolevulinic acid confocal patterns were difficult to establish. No intraoperative complications related to pCLE or to use of either contrast agent were observed.
CONCLUSION:We report the initial feasibility and safety of intraoperative pCLE during primary brain tumor resection and stereotactic biopsy procedures. Pending further investigation, pCLE of brain tissue could be utilized for intraoperative surgical guidance, improvement in brain biopsy yield, and optimization of glioma resection via analysis of tumor margins.
ABBREVIATIONS:5-ALA, 5-aminolevulinic acidpCLE, probe-based confocal laser endomicroscopyPpIX, protoporphyrin IX</abstract><cop>United States</cop><pub>Copyright by the Congress of Neurological Surgeons</pub><pmid>27643918</pmid><doi>10.1227/NEU.0000000000001365</doi><tpages>9</tpages></addata></record> |
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| subjects | Adult Aged Biopsy Biopsy, Needle Brain cancer Brain Neoplasms - diagnosis Brain Neoplasms - surgery Contrast Media Feasibility Studies Female Glioma Glioma - diagnosis Glioma - surgery Humans Intraoperative Period Male Microscopy, Confocal - methods Middle Aged Prospective Studies Stereotaxic Techniques Surgery |
| title | Intraoperative Probe-Based Confocal Laser Endomicroscopy in Surgery and Stereotactic Biopsy of Low-Grade and High-Grade Gliomas: A Feasibility Study in Humans |
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