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Fluorescence Imaging of Nerves During Surgery.
Erika M Walsh1, Denzel Cole2, Kiranya E Tipirneni2
1Michigan Ear Institute, Farmington Hills, MI.
Annals of Surgery
|January 17, 2019
Summary
Developing ideal nerve-specific fluorescent agents for surgery is challenging. Current agents show promise but lack standardized data on nerve visualization and toxicity, hindering optimal intraoperative nerve identification.
Area of Science:
- Surgical Navigation
- Medical Imaging
- Biochemistry
Background:
- Iatrogenic nerve injury is a significant surgical morbidity.
- Current nerve identification methods (neurophysiologic stimulation) have limitations.
- Intraoperative fluorescence imaging offers complementary tissue differentiation.
Purpose of the Study:
- To review agents for fluorescence-guided nerve imaging in preclinical and clinical settings.
- To identify factors for selecting nerve-specific fluorescent agents for surgery.
- To assess the current state and challenges in developing ideal nerve imaging agents.
Main Methods:
- PubMed search conducted in February 2018 for peripheral nerve fluorescence.
- Key search terms included 'intraoperative, nerve, fluorescence, peripheral nerve, visualization, near infrared, and myelin'.
- Article references were cross-checked to identify additional relevant studies.
Main Results:
- Axonal transport tracers showed greatest specificity among nonspecific agents.
- Nerve-specific fluorophores provide excellent nerve-to-background ratios.
- Data on quantifying nerve-specific fluorescence and toxicity are limited across studies.
Conclusions:
- Fluorescence-based nerve enhancement has advanced significantly.
- An ideal agent should be perioperatively administered, non-blood-brain barrier crossing, and near-infrared emitting.
- Systemic agents targeting nerve-specific moieties show promise, but optimal agent development remains challenging due to study heterogeneity.
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