Confocal Scanning Microscopy Provides Rapid, Detailed Intraoperative Histological Assessment of Brain Neoplasms: Experience with 106 Cases

Publication date: Available online 21 March 2018
Source:Clinical Neurology and Neurosurgery
Author(s): Nikolay L. Martirosyan, Joseph Georges, Jennifer M. Eschbacher, Evgenii Belykh, Alessandro Carotenuto, Robert F. Spetzler, Peter Nakaji, Mark C. Preul
ObjectivesFrozen section histological analysis is currently the mainstay for intraprocedural tissue diagnosis during the resection of intracranial neoplasms and for evaluating tumor margins. However, frozen sections are time-consuming and often do not reveal the histological features needed for final diagnosis when compared with permanent sections. Confocal scanning microscopy (CSM) with certain stains may be a valuable technology that can add rapid and detailed histological assessment advantage for the neurosurgical operating room. This study describes potential advantages of CSM imaging of fresh human brain tumor tissues labeled with acriflavine (AF), acridine orange (AO) and cresyl violet (CV) within the neurosurgical operating room facility.Patients and Methods Acute slices from orthotopic human intracranial neoplasms were incubated with AF/AO and CV solutions for 10 seconds and 1 minute respectively. Samples were imaged using a bench-top CSM system. Histopathologic features of corresponding CSM and permanent hematoxylin and eosin images were reviewed for each case.ResultsOf 106 cases, 30 were meningiomas, 19 gliomas, 13 pituitary adenomas, 9 metastases, 6 schwannomas, 4 ependymomas, and 25 other pathologies. CSM with the addition of rapid fluorophores revealed striking microvascular, cellular and subcellular structures that correlated with conventional histology. By rapidly staining and optically sectioning freshly resected tissue, images were generated for intraoperative consultations in less than one minute. With this technique, an entire resected tissue sample was imaged and digitally stored for tele-pathology and archiving.ConclusionCSM of fresh human brain tumor tissue provides clinically meaningful and rapid histopathological assessment much faster than frozen section. With appropriate stains, including specific cellular structure or antibody staining, CSM could improve the timeliness of intraoperative decision-making, and the neurosurgical-pathology workflow during resection of human brain tumors, ultimately improving patient care.



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