Confocal Laser Endomicroscopy: Enhancing Intraoperative Decision Making in Neurosurgery
Brain tumors, both primary and metastatic, represent a significant global health burden due to their high incidence, mortality, and the severe neurological deficits they frequently cause. Gliomas, especially high-grade gliomas (HGGs), rank among the most aggressive and lethal neoplasms, with only mo...
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MDPI AG
2025-02-01
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| author | Francesco Carbone Nicola Pio Fochi Giuseppe Di Perna Arthur Wagner Jürgen Schlegel Elena Ranieri Uwe Spetzger Daniele Armocida Fabio Cofano Diego Garbossa Augusto Leone Antonio Colamaria |
| author_facet | Francesco Carbone Nicola Pio Fochi Giuseppe Di Perna Arthur Wagner Jürgen Schlegel Elena Ranieri Uwe Spetzger Daniele Armocida Fabio Cofano Diego Garbossa Augusto Leone Antonio Colamaria |
| author_sort | Francesco Carbone |
| collection | DOAJ |
| description | Brain tumors, both primary and metastatic, represent a significant global health burden due to their high incidence, mortality, and the severe neurological deficits they frequently cause. Gliomas, especially high-grade gliomas (HGGs), rank among the most aggressive and lethal neoplasms, with only modest gains in long-term survival despite extensive molecular research and established standard therapies. In neurosurgical practice, maximizing the extent of safe resection is a principal strategy for improving clinical outcomes. Yet, the infiltrative nature of gliomas often complicates the accurate delineation of tumor margins. Confocal laser endomicroscopy (CLE), originally introduced in gastroenterology, has recently gained prominence in neuro-oncology by enabling real-time, high-resolution cellular imaging during surgery. This technique allows for intraoperative tumor characterization and reduces dependence on time-consuming frozen-section analyses. Recent technological advances, including device miniaturization and second-generation CLE systems, have substantially improved image quality and diagnostic utility. Furthermore, integration with deep learning algorithms and telepathology platforms fosters automated image interpretation and remote expert consultations, thereby accelerating surgical decision making and enhancing diagnostic consistency. Future work should address remaining challenges, such as mitigating motion artifacts, refining training protocols, and broadening the range of applicable fluorescent probes, to solidify CLE’s role as a critical intraoperative adjunct in neurosurgical oncology. |
| format | Article |
| id | doaj-art-4be62f9690c1441fa7abab00890e9f5a |
| institution | DOAJ |
| issn | 2075-4418 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Diagnostics |
| spelling | doaj-art-4be62f9690c1441fa7abab00890e9f5a2025-08-20T02:44:56ZengMDPI AGDiagnostics2075-44182025-02-0115449910.3390/diagnostics15040499Confocal Laser Endomicroscopy: Enhancing Intraoperative Decision Making in NeurosurgeryFrancesco Carbone0Nicola Pio Fochi1Giuseppe Di Perna2Arthur Wagner3Jürgen Schlegel4Elena Ranieri5Uwe Spetzger6Daniele Armocida7Fabio Cofano8Diego Garbossa9Augusto Leone10Antonio Colamaria11Department of Neurosurgery, Karlsruher Neurozentrum, Städtisches Klinikum Karlsruhe, 76133 Karlsruhe, GermanyDepartment of Neurosurgery, Università degli Studi di Torino, 10125 Torino, ItalyDivision of Neurosurgery, Policlinico “Riuniti”, University of Foggia, 71122 Foggia, ItalyDepartment of Neurosurgery, Klinikum rechts der Isar, Technical University Munich School of Medicine, 81675 Munich, GermanyDepartment of Neuropathology, Klinikum rechts der Isar, Technical University Munich School of Medicine, 81675 Munich, GermanyUnit of Clinical Pathology, Advanced Research Center on Kidney Aging (A.R.K.A.), Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, ItalyDepartment of Neurosurgery, Karlsruher Neurozentrum, Städtisches Klinikum Karlsruhe, 76133 Karlsruhe, GermanyIRCCS Istituto Neurologico Mediterraneo Neuromed, 86077 Roma, ItalyDepartment of Neurosurgery, Università degli Studi di Torino, 10125 Torino, ItalyDepartment of Neurosurgery, Università degli Studi di Torino, 10125 Torino, ItalyDepartment of Neurosurgery, Karlsruher Neurozentrum, Städtisches Klinikum Karlsruhe, 76133 Karlsruhe, GermanyDivision of Neurosurgery, Policlinico “Riuniti”, University of Foggia, 71122 Foggia, ItalyBrain tumors, both primary and metastatic, represent a significant global health burden due to their high incidence, mortality, and the severe neurological deficits they frequently cause. Gliomas, especially high-grade gliomas (HGGs), rank among the most aggressive and lethal neoplasms, with only modest gains in long-term survival despite extensive molecular research and established standard therapies. In neurosurgical practice, maximizing the extent of safe resection is a principal strategy for improving clinical outcomes. Yet, the infiltrative nature of gliomas often complicates the accurate delineation of tumor margins. Confocal laser endomicroscopy (CLE), originally introduced in gastroenterology, has recently gained prominence in neuro-oncology by enabling real-time, high-resolution cellular imaging during surgery. This technique allows for intraoperative tumor characterization and reduces dependence on time-consuming frozen-section analyses. Recent technological advances, including device miniaturization and second-generation CLE systems, have substantially improved image quality and diagnostic utility. Furthermore, integration with deep learning algorithms and telepathology platforms fosters automated image interpretation and remote expert consultations, thereby accelerating surgical decision making and enhancing diagnostic consistency. Future work should address remaining challenges, such as mitigating motion artifacts, refining training protocols, and broadening the range of applicable fluorescent probes, to solidify CLE’s role as a critical intraoperative adjunct in neurosurgical oncology.https://www.mdpi.com/2075-4418/15/4/499brain tumorconfocal laser endomicroscopyintraoperative pathologyimage-guided surgeryfluorescence-guided surgery |
| spellingShingle | Francesco Carbone Nicola Pio Fochi Giuseppe Di Perna Arthur Wagner Jürgen Schlegel Elena Ranieri Uwe Spetzger Daniele Armocida Fabio Cofano Diego Garbossa Augusto Leone Antonio Colamaria Confocal Laser Endomicroscopy: Enhancing Intraoperative Decision Making in Neurosurgery Diagnostics brain tumor confocal laser endomicroscopy intraoperative pathology image-guided surgery fluorescence-guided surgery |
| title | Confocal Laser Endomicroscopy: Enhancing Intraoperative Decision Making in Neurosurgery |
| title_full | Confocal Laser Endomicroscopy: Enhancing Intraoperative Decision Making in Neurosurgery |
| title_fullStr | Confocal Laser Endomicroscopy: Enhancing Intraoperative Decision Making in Neurosurgery |
| title_full_unstemmed | Confocal Laser Endomicroscopy: Enhancing Intraoperative Decision Making in Neurosurgery |
| title_short | Confocal Laser Endomicroscopy: Enhancing Intraoperative Decision Making in Neurosurgery |
| title_sort | confocal laser endomicroscopy enhancing intraoperative decision making in neurosurgery |
| topic | brain tumor confocal laser endomicroscopy intraoperative pathology image-guided surgery fluorescence-guided surgery |
| url | https://www.mdpi.com/2075-4418/15/4/499 |
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