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Updated: Jul 27, 2025
Longitudinal Intravital Imaging of Brain Tumor Cell Behavior in Response to an Invasive Surgical Biopsy
Published on: May 3, 2019
Intraoperative confocal laser endomicroscopy for brain tumors - potential and challenges from a neuropathological
Theoni Maragkou1, Karl Quint2, Bianca Pollo3
1Institute of Pathology, University of Bern, Bern, Switzerland.
Abstract:
Confocal laser endomicroscopy (CLE) represents a new non-invasive in vivo imaging technique that holds considerable promise in neurosurgery and neuropathology. CLE is based on the principle of optical sectioning which uses pinholes placed in the light path to selectively image photons of a specific focal plane by filtering out photons above and below the focal plane. Potential indications of CLE in neurosurgery and neuropathology include intraoperative tumor diagnosis and staging as well as assessment of tumor resection margins notably in the case of diffusely infiltrating gliomas. CLE-based tumor analysis in near-real time may also have a significant impact on future tumor resection strategies. We here discuss the technical features of CLE, its potential for wide-field imaging, its role in comparison to established histological techniques for intraoperative tumor assessment and its position in digital pathology and telepathology. Based on our group's experience with a commercially available confocal laser endomicroscope (ZEISS CONVIVO), we critically address the current state of intraoperative CLE in brain tumor surgery, the applicability of classical histological criteria and the strategies required to further improve the diagnostic accuracy of CLE. We finally discuss how a widespread use of CLE in neurosurgery may modify the role of neuropathologists in intraoperative consultation, generating both new opportunities and new challenges.
Insights
Confocal laser endomicroscopy (CLE) offers a promising non-invasive method for real-time brain tumor analysis during surgery. This technique aids in intraoperative diagnosis, staging, and margin assessment, potentially transforming neurosurgical strategies.
Area of Science:
- Neurosurgery
- Neuropathology
- Medical Imaging
Background:
- Confocal laser endomicroscopy (CLE) is an emerging non-invasive in vivo imaging technology.
- CLE utilizes optical sectioning with pinholes to achieve selective imaging of a specific focal plane.
Purpose of the Study:
- To discuss the technical features and potential applications of CLE in neurosurgery and neuropathology.
- To evaluate CLE's role in intraoperative tumor diagnosis, staging, and margin assessment, particularly for gliomas.
- To compare CLE with established histological techniques and explore its position in digital and telepathology.
Main Methods:
- Discussion of technical aspects of CLE and its wide-field imaging capabilities.
- Critical review of intraoperative CLE in brain tumor surgery based on practical experience.
- Analysis of the applicability of classical histological criteria and strategies for improving CLE diagnostic accuracy.
Main Results:
- CLE shows considerable promise for intraoperative tumor diagnosis and staging.
- Near-real-time CLE analysis can significantly impact tumor resection strategies.
- CLE may redefine the role of neuropathologists in intraoperative consultations.
Conclusions:
- CLE presents a valuable tool for neurosurgery and neuropathology, offering non-invasive, real-time imaging.
- Further development is needed to enhance CLE's diagnostic accuracy for brain tumors.
- Widespread adoption of CLE could lead to significant changes in intraoperative neurosurgical workflows and neuropathology consultations.
