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Raghunathan R, Vasquez M, Zhang K, Zhao H, Wong STC. Label-free optical imaging for brain cancer assessment. Trends Cancer 2024; 10:557-570. [PMID: 38575412 PMCID: PMC11168891 DOI: 10.1016/j.trecan.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 03/12/2024] [Accepted: 03/13/2024] [Indexed: 04/06/2024]
Abstract
Advances in label-free optical imaging offer a promising avenue for brain cancer assessment, providing high-resolution, real-time insights without the need for radiation or exogeneous agents. These cost-effective and intricately detailed techniques overcome the limitations inherent in magnetic resonance imaging (MRI), computed tomography (CT), and positron emission tomography (PET) scans by offering superior resolution and more readily accessible imaging options. This comprehensive review explores a variety of such methods, including photoacoustic imaging (PAI), optical coherence tomography (OCT), Raman imaging, and IR microscopy. It focuses on their roles in the detection, diagnosis, and management of brain tumors. By highlighting recent advances in these imaging techniques, the review aims to underscore the importance of label-free optical imaging in enhancing early detection and refining therapeutic strategies for brain cancer.
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Affiliation(s)
- Raksha Raghunathan
- Department of Systems Medicine and Bioengineering and T.T. and W.F. Chao Center for BRAIN, Houston Methodist Neal Cancer Center, Houston Methodist Hospital, Houston, TX 77030, USA; Advanced Cellular and Tissue Microscopy Core, Houston Methodist Neal Cancer Center and Houston Methodist Research Institute, Houston, TX 77030, USA
| | - Matthew Vasquez
- Department of Systems Medicine and Bioengineering and T.T. and W.F. Chao Center for BRAIN, Houston Methodist Neal Cancer Center, Houston Methodist Hospital, Houston, TX 77030, USA; Advanced Cellular and Tissue Microscopy Core, Houston Methodist Neal Cancer Center and Houston Methodist Research Institute, Houston, TX 77030, USA
| | - Katherine Zhang
- Department of Systems Medicine and Bioengineering and T.T. and W.F. Chao Center for BRAIN, Houston Methodist Neal Cancer Center, Houston Methodist Hospital, Houston, TX 77030, USA; Advanced Cellular and Tissue Microscopy Core, Houston Methodist Neal Cancer Center and Houston Methodist Research Institute, Houston, TX 77030, USA
| | - Hong Zhao
- Department of Systems Medicine and Bioengineering and T.T. and W.F. Chao Center for BRAIN, Houston Methodist Neal Cancer Center, Houston Methodist Hospital, Houston, TX 77030, USA; Advanced Cellular and Tissue Microscopy Core, Houston Methodist Neal Cancer Center and Houston Methodist Research Institute, Houston, TX 77030, USA; Department of Medicine, Weill Cornell Medicine, New York, NY 10065, USA.
| | - Stephen T C Wong
- Department of Systems Medicine and Bioengineering and T.T. and W.F. Chao Center for BRAIN, Houston Methodist Neal Cancer Center, Houston Methodist Hospital, Houston, TX 77030, USA; Advanced Cellular and Tissue Microscopy Core, Houston Methodist Neal Cancer Center and Houston Methodist Research Institute, Houston, TX 77030, USA; Departments of Radiology, Pathology, and Laboratory Medicine and Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY 10065, USA
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Pillar N, Li Y, Zhang Y, Ozcan A. Virtual Staining of Nonfixed Tissue Histology. Mod Pathol 2024; 37:100444. [PMID: 38325706 DOI: 10.1016/j.modpat.2024.100444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 01/19/2024] [Accepted: 01/29/2024] [Indexed: 02/09/2024]
Abstract
Surgical pathology workflow involves multiple labor-intensive steps, such as tissue removal, fixation, embedding, sectioning, staining, and microscopic examination. This process is time-consuming and costly and requires skilled technicians. In certain clinical scenarios, such as intraoperative consultations, there is a need for faster histologic evaluation to provide real-time surgical guidance. Currently, frozen section techniques involving hematoxylin and eosin (H&E) staining are used for intraoperative pathology consultations. However, these techniques have limitations, including a turnaround time of 20 to 30 minutes, staining artifacts, and potential tissue loss, negatively impacting accurate diagnosis. To address these challenges, researchers are exploring alternative optical imaging modalities for rapid microscopic tissue imaging. These modalities differ in optical characteristics, tissue preparation requirements, imaging equipment, and output image quality and format. Some of these imaging methods have been combined with computational algorithms to generate H&E-like images, which could greatly facilitate their adoption by pathologists. Here, we provide a comprehensive, organ-specific review of the latest advancements in emerging imaging modalities applied to nonfixed human tissue. We focused on studies that generated H&E-like images evaluated by pathologists. By presenting up-to-date research progress and clinical utility, this review serves as a valuable resource for scholars and clinicians, covering some of the major technical developments in this rapidly evolving field. It also offers insights into the potential benefits and drawbacks of alternative imaging modalities and their implications for improving patient care.
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Affiliation(s)
- Nir Pillar
- Electrical and Computer Engineering Department, University of California, Los Angeles, California; Bioengineering Department, University of California, Los Angeles, California; California NanoSystems Institute (CNSI), University of California, Los Angeles, California
| | - Yuzhu Li
- Electrical and Computer Engineering Department, University of California, Los Angeles, California; Bioengineering Department, University of California, Los Angeles, California; California NanoSystems Institute (CNSI), University of California, Los Angeles, California
| | - Yijie Zhang
- Electrical and Computer Engineering Department, University of California, Los Angeles, California; Bioengineering Department, University of California, Los Angeles, California; California NanoSystems Institute (CNSI), University of California, Los Angeles, California
| | - Aydogan Ozcan
- Electrical and Computer Engineering Department, University of California, Los Angeles, California; Bioengineering Department, University of California, Los Angeles, California; California NanoSystems Institute (CNSI), University of California, Los Angeles, California.
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3
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Meißner AK, Goldbrunner R, Neuschmelting V. [Intraoperative stimulated Raman histology for personalized brain tumor surgery]. CHIRURGIE (HEIDELBERG, GERMANY) 2024; 95:274-279. [PMID: 38334774 DOI: 10.1007/s00104-024-02038-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/11/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND In brain tumor surgery a personalized surgical approach is crucial to achieve a maximum safe tumor resection. The extent of resection decisively depends on the histological diagnosis. Stimulated Raman histology (SRH), a fiber laser-based optical imaging method, offers the possibility for evaluation of an intraoperative diagnosis in a few minutes. OBJECTIVE To provide an overview on the applications of SRH in neurosurgery and transference of the technique to other surgical disciplines. METHODS Description of the technique and review of the current literature on SRH. RESULTS The SRH technique was successfully used in multiple neuro-oncological tumor entities. Initial pilot projects showed the potential for analysis of extracranial tumors. CONCLUSION The use of SRH provides a near real-time diagnosis with high diagnostic accuracy and provides further developmental potential to improve personalized tumor surgery.
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Affiliation(s)
- Anna-Katharina Meißner
- Klinik für allgemeine Neurochirurgie, Zentrum für Neurochirurgie, Medizinische Fakultät und Universitätsklinik Köln, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - Roland Goldbrunner
- Klinik für allgemeine Neurochirurgie, Zentrum für Neurochirurgie, Medizinische Fakultät und Universitätsklinik Köln, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - Volker Neuschmelting
- Klinik für allgemeine Neurochirurgie, Zentrum für Neurochirurgie, Medizinische Fakultät und Universitätsklinik Köln, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
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Al-Adli NN, Young JS, Scotford K, Sibih YE, Payne J, Berger MS. Advances in Intraoperative Glioma Tissue Sampling and Infiltration Assessment. Brain Sci 2023; 13:1637. [PMID: 38137085 PMCID: PMC10741454 DOI: 10.3390/brainsci13121637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 11/06/2023] [Accepted: 11/21/2023] [Indexed: 12/24/2023] Open
Abstract
Gliomas are infiltrative brain tumors that often involve functional tissue. While maximal safe resection is critical for maximizing survival, this is challenged by the difficult intraoperative discrimination between tumor-infiltrated and normal structures. Surgical expertise is essential for identifying safe margins, and while the intraoperative pathological review of frozen tissue is possible, this is a time-consuming task. Advances in intraoperative stimulation mapping have aided surgeons in identifying functional structures and, as such, has become the gold standard for this purpose. However, intraoperative margin assessment lacks a similar consensus. Nonetheless, recent advances in intraoperative imaging techniques and tissue examination methods have demonstrated promise for the accurate and efficient assessment of tumor infiltration and margin delineation within the operating room, respectively. In this review, we describe these innovative technologies that neurosurgeons should be aware of.
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Affiliation(s)
- Nadeem N. Al-Adli
- Department of Neurosurgery, University of California San Francisco, San Francisco, CA 94131, USA; (N.N.A.-A.); (J.S.Y.); (K.S.); (J.P.)
- School of Medicine, Texas Christian University, Fort Worth, TX 76109, USA
| | - Jacob S. Young
- Department of Neurosurgery, University of California San Francisco, San Francisco, CA 94131, USA; (N.N.A.-A.); (J.S.Y.); (K.S.); (J.P.)
| | - Katie Scotford
- Department of Neurosurgery, University of California San Francisco, San Francisco, CA 94131, USA; (N.N.A.-A.); (J.S.Y.); (K.S.); (J.P.)
| | - Youssef E. Sibih
- School of Medicine, University of California San Francisco, San Francisco, CA 94131, USA;
| | - Jessica Payne
- Department of Neurosurgery, University of California San Francisco, San Francisco, CA 94131, USA; (N.N.A.-A.); (J.S.Y.); (K.S.); (J.P.)
| | - Mitchel S. Berger
- Department of Neurosurgery, University of California San Francisco, San Francisco, CA 94131, USA; (N.N.A.-A.); (J.S.Y.); (K.S.); (J.P.)
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Zhang J, Straehle J, Joseph K, Neidert N, Behringer S, Göldner J, Vlachos A, Prinz M, Fung C, Beck J, Schnell O, Heiland DH, Ravi VM. Isolation and profiling of viable tumor cells from human ex vivo glioblastoma cultures through single-cell transcriptomics. STAR Protoc 2023; 4:102383. [PMID: 37393609 PMCID: PMC10328984 DOI: 10.1016/j.xpro.2023.102383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 04/06/2023] [Accepted: 05/25/2023] [Indexed: 07/04/2023] Open
Abstract
Single-cell RNA-sequencing (scRNA-seq) is becoming a ubiquitous method in profiling the cellular transcriptomes of both malignant and non-malignant cells from the human brain. Here, we present a protocol to isolate viable tumor cells from human ex vivo glioblastoma cultures for single-cell transcriptomic analysis. We describe steps including surgical tissue collection, sectioning, culturing, primary tumor cells inoculation, growth tracking, fluorescence-based cell sorting, and population-enriched scRNA-seq. This comprehensive methodology empowers in-depth understanding of brain tumor biology at the single-cell level. For complete details on the use and execution of this protocol, please refer to Ravi et al.1.
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Affiliation(s)
- Junyi Zhang
- 3D-Brain Models for Neurodegenerative Diseases, Medical Center, University of Freiburg, Freiburg, Germany; Microenvironment and Immunology Research Laboratory, Medical Center, University of Freiburg, Freiburg, Germany; Department of Neurosurgery, Medical Center, University of Freiburg, Freiburg, Germany; Faculty of Medicine, University of Freiburg, Freiburg, Germany; Translational NeuroOncology Research Group, Medical Center - University of Freiburg, Freiburg, Germany
| | - Jakob Straehle
- Department of Neurosurgery, Medical Center, University of Freiburg, Freiburg, Germany; Center of Advanced Surgical Tissue Analysis (CAST), University of Freiburg, Freiburg, Germany; Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Kevin Joseph
- NeuroEngineering Laboratory, Medical Centre, University of Freiburg, Freiburg, Germany; Department of Neurosurgery, Medical Center, University of Freiburg, Freiburg, Germany; Center of Advanced Surgical Tissue Analysis (CAST), University of Freiburg, Freiburg, Germany; Faculty of Medicine, University of Freiburg, Freiburg, Germany; Translational NeuroOncology Research Group, Medical Center - University of Freiburg, Freiburg, Germany
| | - Nicolas Neidert
- Department of Neurosurgery, Medical Center, University of Freiburg, Freiburg, Germany; Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Simon Behringer
- Department of Neurosurgery, Medical Center, University of Freiburg, Freiburg, Germany; Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jonathan Göldner
- 3D-Brain Models for Neurodegenerative Diseases, Medical Center, University of Freiburg, Freiburg, Germany; Microenvironment and Immunology Research Laboratory, Medical Center, University of Freiburg, Freiburg, Germany; Department of Neurosurgery, Medical Center, University of Freiburg, Freiburg, Germany; Faculty of Medicine, University of Freiburg, Freiburg, Germany; Translational NeuroOncology Research Group, Medical Center - University of Freiburg, Freiburg, Germany
| | - Andreas Vlachos
- Department of Neuroanatomy, Institute of Anatomy and Cell Biology, Faculty of Medicine, University of Freiburg, Freiburg, Germany; BrainLinks-BrainTools Center, University of Freiburg, Freiburg, Germany; Center for Basics in Neuromodulation (NeuroModulBasics), Faculty of Medicine, University of Freiburg, Freiburg, Germany; Center for NeuroModulation (NeuroModul), University of Freiburg, Freiburg, Germany
| | - Marco Prinz
- Faculty of Medicine, University of Freiburg, Freiburg, Germany; Center for Basics in Neuromodulation (NeuroModulBasics), Faculty of Medicine, University of Freiburg, Freiburg, Germany; Center for NeuroModulation (NeuroModul), University of Freiburg, Freiburg, Germany; Institute of Neuropathology, Medical Center - University of Freiburg, Freiburg, Germany; Signalling Research Centres BIOSS and CIBSS, University of Freiburg, Freiburg, Germany
| | - Christian Fung
- Department of Neurosurgery, Medical Center, University of Freiburg, Freiburg, Germany; Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jürgen Beck
- Department of Neurosurgery, Medical Center, University of Freiburg, Freiburg, Germany; Center of Advanced Surgical Tissue Analysis (CAST), University of Freiburg, Freiburg, Germany; Faculty of Medicine, University of Freiburg, Freiburg, Germany; Center for Basics in Neuromodulation (NeuroModulBasics), Faculty of Medicine, University of Freiburg, Freiburg, Germany; Comprehensive Cancer Center Freiburg (CCCF), Faculty of Medicine and Medical Center- University of Freiburg, Freiburg, Germany
| | - Oliver Schnell
- Department of Neurosurgery, Medical Center, University of Freiburg, Freiburg, Germany; Center of Advanced Surgical Tissue Analysis (CAST), University of Freiburg, Freiburg, Germany; Faculty of Medicine, University of Freiburg, Freiburg, Germany; Translational NeuroOncology Research Group, Medical Center - University of Freiburg, Freiburg, Germany
| | - Dieter Henrik Heiland
- Microenvironment and Immunology Research Laboratory, Medical Center, University of Freiburg, Freiburg, Germany; Department of Neurosurgery, Medical Center, University of Freiburg, Freiburg, Germany; Center of Advanced Surgical Tissue Analysis (CAST), University of Freiburg, Freiburg, Germany; Faculty of Medicine, University of Freiburg, Freiburg, Germany; Translational NeuroOncology Research Group, Medical Center - University of Freiburg, Freiburg, Germany; Comprehensive Cancer Center Freiburg (CCCF), Faculty of Medicine and Medical Center- University of Freiburg, Freiburg, Germany; German Cancer Consortium (DKTK), Partner Site Freiburg; Department of Neurological Surgery, Lou and Jean Malnati Brain Tumor Institute, Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Vidhya M Ravi
- 3D-Brain Models for Neurodegenerative Diseases, Medical Center, University of Freiburg, Freiburg, Germany; Department of Neurosurgery, Medical Center, University of Freiburg, Freiburg, Germany; Center of Advanced Surgical Tissue Analysis (CAST), University of Freiburg, Freiburg, Germany; Faculty of Medicine, University of Freiburg, Freiburg, Germany; Translational NeuroOncology Research Group, Medical Center - University of Freiburg, Freiburg, Germany; Freiburg Institute of Advanced Studies (FRIAS), Freiburg, Germany.
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Murugappan S, Tofail SAM, Thorat ND. Raman Spectroscopy: A Tool for Molecular Fingerprinting of Brain Cancer. ACS OMEGA 2023; 8:27845-27861. [PMID: 37576695 PMCID: PMC10413827 DOI: 10.1021/acsomega.3c01848] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 07/12/2023] [Indexed: 08/15/2023]
Abstract
Brain cancer is one of those few cancers with very high mortality and low five-year survival rate. First and foremost reason for the woes is the difficulty in diagnosing and monitoring the progression of brain tumors both benign and malignant, noninvasively and in real time. This raises a need in this hour for a tool to diagnose the tumors in the earliest possible time frame. On the other hand, Raman spectroscopy which is well-known for its ability to precisely represent the molecular markers available in any sample given, including biological ones, with great sensitivity and specificity. This has led to a number of studies where Raman spectroscopy has been used in brain tumors in various ways. This review article highlights the fundamentals of Raman spectroscopy and its types including conventional Raman, SERS, SORS, SRS, CARS, etc. are used in brain tumors for diagnostics, monitoring, and even theragnostics, collating all the major works in the area. Also, the review explores how Raman spectroscopy can be even more effectively used in theragnostics and the clinical level which would make them a one-stop solution for all brain cancer needs in the future.
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Affiliation(s)
- Sivasubramanian Murugappan
- Department of Physics, Bernal
Institute and Limerick Digital Cancer Research Centre (LDCRC)
University of Limerick, Castletroy, Limerick V94T9PX, Ireland
| | - Syed A. M. Tofail
- Department of Physics, Bernal
Institute and Limerick Digital Cancer Research Centre (LDCRC)
University of Limerick, Castletroy, Limerick V94T9PX, Ireland
| | - Nanasaheb D. Thorat
- Department of Physics, Bernal
Institute and Limerick Digital Cancer Research Centre (LDCRC)
University of Limerick, Castletroy, Limerick V94T9PX, Ireland
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Steybe D, Poxleitner P, Metzger MC, Rothweiler R, Beck J, Straehle J, Vach K, Weber A, Enderle-Ammour K, Werner M, Schmelzeisen R, Bronsert P. Stimulated Raman histology for histological evaluation of oral squamous cell carcinoma. Clin Oral Investig 2023; 27:4705-4713. [PMID: 37349642 PMCID: PMC10415463 DOI: 10.1007/s00784-023-05098-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 05/25/2023] [Indexed: 06/24/2023]
Abstract
OBJECTIVES To investigate whether in patients undergoing surgery for oral squamous cell carcinoma, stimulated Raman histology (SRH), in comparison with H&E-stained frozen sections, can provide accurate diagnoses regarding neoplastic tissue and sub-classification of non-neoplastic tissues. MATERIALS AND METHODS SRH, a technology based on Raman scattering, was applied to generate digital histopathologic images of 80 tissue samples obtained from 8 oral squamous cell carcinoma (OSCC) patients. Conventional H&E-stained frozen sections were then obtained from all 80 samples. All images/sections (SRH and H&E) were analyzed for squamous cell carcinoma, normal mucosa, connective tissue, muscle tissue, adipose tissue, salivary gland tissue, lymphatic tissue, and inflammatory cells. Agreement between SRH and H&E was evaluated by calculating Cohen's kappa. Accuracy of SRH compared to H&E was quantified by calculating sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) as well as area under the receiver operating characteristic curve (AUC). RESULTS Thirty-six of 80 samples were classified as OSCC by H&E-based diagnosis. Regarding the differentiation between neoplastic and non-neoplastic tissue, high agreement between H&E and SRH (kappa: 0.880) and high accuracy of SRH (sensitivity: 100%; specificity: 90.91%; PPV: 90.00%, NPV: 100%; AUC: 0.954) were demonstrated. For sub-classification of non-neoplastic tissues, SRH performance was dependent on the type of tissue, with high agreement and accuracy for normal mucosa, muscle tissue, and salivary glands. CONCLUSION SRH provides high accuracy in discriminating neoplastic and non-neoplastic tissues. Regarding sub-classification of non-neoplastic tissues in OSCC patients, accuracy varies depending on the type of tissue examined. CLINICAL RELEVANCE This study demonstrates the potential of SRH for intraoperative imaging of fresh, unprocessed tissue specimens from OSCC patients without the need for sectioning or staining.
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Affiliation(s)
- David Steybe
- Department of Oral and Maxillofacial Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
- Center for Advanced Surgical Tissue Analysis (CAST), University of Freiburg, Freiburg, Germany.
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, LMU University Hospital, LMU Munich, Lindwurmstrasse 2a, 80337, Munich, Germany.
| | - Philipp Poxleitner
- Department of Oral and Maxillofacial Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, LMU University Hospital, LMU Munich, Lindwurmstrasse 2a, 80337, Munich, Germany
| | - Marc C Metzger
- Department of Oral and Maxillofacial Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - René Rothweiler
- Department of Oral and Maxillofacial Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jürgen Beck
- Center for Advanced Surgical Tissue Analysis (CAST), University of Freiburg, Freiburg, Germany
- Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jakob Straehle
- Center for Advanced Surgical Tissue Analysis (CAST), University of Freiburg, Freiburg, Germany
- Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Kirstin Vach
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Andreas Weber
- Institute for Surgical Pathology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Kathrin Enderle-Ammour
- Institute for Surgical Pathology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Martin Werner
- Institute for Surgical Pathology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Tumorbank Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Freiburg, Germany
| | - Rainer Schmelzeisen
- Department of Oral and Maxillofacial Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Center for Advanced Surgical Tissue Analysis (CAST), University of Freiburg, Freiburg, Germany
| | - Peter Bronsert
- Institute for Surgical Pathology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Tumorbank Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Freiburg, Germany
- Core Facility for Histopathology and Digital Pathology, Medical Center, University of Freiburg, Freiburg, Germany
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Fürtjes G, Reinecke D, von Spreckelsen N, Meißner AK, Rueß D, Timmer M, Freudiger C, Ion-Margineanu A, Khalid F, Watrinet K, Mawrin C, Chmyrov A, Goldbrunner R, Bruns O, Neuschmelting V. Intraoperative microscopic autofluorescence detection and characterization in brain tumors using stimulated Raman histology and two-photon fluorescence. Front Oncol 2023; 13:1146031. [PMID: 37234975 PMCID: PMC10207900 DOI: 10.3389/fonc.2023.1146031] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 04/21/2023] [Indexed: 05/28/2023] Open
Abstract
Introduction The intrinsic autofluorescence of biological tissues interferes with the detection of fluorophores administered for fluorescence guidance, an emerging auxiliary technique in oncological surgery. Yet, autofluorescence of the human brain and its neoplasia is sparsely examined. This study aims to assess autofluorescence of the brain and its neoplasia on a microscopic level by stimulated Raman histology (SRH) combined with two-photon fluorescence. Methods With this experimentally established label-free microscopy technique unprocessed tissue can be imaged and analyzed within minutes and the process is easily incorporated in the surgical workflow. In a prospective observational study, we analyzed 397 SRH and corresponding autofluorescence images of 162 samples from 81 consecutive patients that underwent brain tumor surgery. Small tissue samples were squashed on a slide for imaging. SRH and fluorescence images were acquired with a dual wavelength laser (790 nm and 1020 nm) for excitation. In these images tumor and non-tumor regions were identified by a convolutional neural network that reliably differentiates between tumor, healthy brain tissue and low quality SRH images. The identified areas were used to define regions.of- interests (ROIs) and the mean fluorescence intensity was measured. Results In healthy brain tissue, we found an increased mean autofluorescence signal in the gray (11.86, SD 2.61, n=29) compared to the white matter (5.99, SD 5.14, n=11, p<0.01) and in the cerebrum (11.83, SD 3.29, n=33) versus the cerebellum (2.82, SD 0.93, n=7, p<0.001), respectively. The signal of carcinoma metastases, meningiomas, gliomas and pituitary adenomas was significantly lower (each p<0.05) compared to the autofluorescence in the cerebrum and dura, and significantly higher (each p<0.05) compared to the cerebellum. Melanoma metastases were found to have a higher fluorescent signal (p<0.01) compared to cerebrum and cerebellum. Discussion In conclusion we found that autofluorescence in the brain varies depending on the tissue type and localization and differs significantly among various brain tumors. This needs to be considered for interpreting photon signal during fluorescence-guided brain tumor surgery.
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Affiliation(s)
- Gina Fürtjes
- Department of General Neurosurgery, Center of Neurosurgery, University Hospital Cologne, Cologne, Germany
- Helmholtz Zentrum München, Neuherberg, Germany
- National Center for Tumor Diseases (NCT/UCC), Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany; Medizinische Fakultät and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany
| | - David Reinecke
- Department of General Neurosurgery, Center of Neurosurgery, University Hospital Cologne, Cologne, Germany
| | - Niklas von Spreckelsen
- Department of General Neurosurgery, Center of Neurosurgery, University Hospital Cologne, Cologne, Germany
| | - Anna-Katharina Meißner
- Department of General Neurosurgery, Center of Neurosurgery, University Hospital Cologne, Cologne, Germany
| | - Daniel Rueß
- Department of Stereotaxy and Functional Neurosurgery, Center of Neurosurgery, University Hospital Cologne, Cologne, Germany
| | - Marco Timmer
- Department of General Neurosurgery, Center of Neurosurgery, University Hospital Cologne, Cologne, Germany
| | | | | | | | | | - Christian Mawrin
- University Hospital Magdeburg, Institute of Neuropathology, Magdeburg, Germany
| | - Andriy Chmyrov
- Helmholtz Zentrum München, Neuherberg, Germany
- National Center for Tumor Diseases (NCT/UCC), Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany; Medizinische Fakultät and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany
| | - Roland Goldbrunner
- Department of General Neurosurgery, Center of Neurosurgery, University Hospital Cologne, Cologne, Germany
| | - Oliver Bruns
- Helmholtz Zentrum München, Neuherberg, Germany
- National Center for Tumor Diseases (NCT/UCC), Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany; Medizinische Fakultät and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany
| | - Volker Neuschmelting
- Department of General Neurosurgery, Center of Neurosurgery, University Hospital Cologne, Cologne, Germany
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Straehle J, Ravi VM, Heiland DH, Galanis C, Lenz M, Zhang J, Neidert NN, El Rahal A, Vasilikos I, Kellmeyer P, Scheiwe C, Klingler JH, Fung C, Vlachos A, Beck J, Schnell O. Technical report: surgical preparation of human brain tissue for clinical and basic research. Acta Neurochir (Wien) 2023; 165:1461-1471. [PMID: 37147485 DOI: 10.1007/s00701-023-05611-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 04/21/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND The study of the distinct structure and function of the human central nervous system, both in healthy and diseased states, is becoming increasingly significant in the field of neuroscience. Typically, cortical and subcortical tissue is discarded during surgeries for tumors and epilepsy. Yet, there is a strong encouragement to utilize this tissue for clinical and basic research in humans. Here, we describe the technical aspects of the microdissection and immediate handling of viable human cortical access tissue for basic and clinical research, highlighting the measures needed to be taken in the operating room to ensure standardized procedures and optimal experimental results. METHODS In multiple rounds of experiments (n = 36), we developed and refined surgical principles for the removal of cortical access tissue. The specimens were immediately immersed in cold carbogenated N-methyl-D-glucamine-based artificial cerebrospinal fluid for electrophysiology and electron microscopy experiments or specialized hibernation medium for organotypic slice cultures. RESULTS The surgical principles of brain tissue microdissection were (1) rapid preparation (<1 min), (2) maintenance of the cortical axis, (3) minimization of mechanical trauma to sample, (4) use of pointed scalpel blade, (5) avoidance of cauterization and blunt preparation, (6) constant irrigation, and (7) retrieval of the sample without the use of forceps or suction. After a single round of introduction to these principles, multiple surgeons adopted the technique for samples with a minimal dimension of 5 mm spanning all cortical layers and subcortical white matter. Small samples (5-7 mm) were ideal for acute slice preparation and electrophysiology. No adverse events from sample resection were observed. CONCLUSION The microdissection technique of human cortical access tissue is safe and easily adoptable into the routine of neurosurgical procedures. The standardized and reliable surgical extraction of human brain tissue lays the foundation for human-to-human translational research on human brain tissue.
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Affiliation(s)
- J Straehle
- Department of Neurosurgery, Medical Center and Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Neuroanatomy, Institute of Anatomy and Cell Biology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Center for Advanced Surgical Tissue Analysis (CAST), Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - V M Ravi
- Department of Neurosurgery, Medical Center and Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Freiburg Institute of Advanced Studies (FRIAS), Freiburg, Germany
| | - D H Heiland
- Department of Neurosurgery, Medical Center and Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Center for Advanced Surgical Tissue Analysis (CAST), Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Neurological Surgery, Lou and Jean Malnati Brain Tumor Institute, Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - C Galanis
- Department of Neuroanatomy, Institute of Anatomy and Cell Biology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - M Lenz
- Department of Neuroanatomy, Institute of Anatomy and Cell Biology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Junyi Zhang
- Department of Neurosurgery, Medical Center and Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - N N Neidert
- Department of Neurosurgery, Medical Center and Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Center for Advanced Surgical Tissue Analysis (CAST), Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - A El Rahal
- Department of Neurosurgery, Medical Center and Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - I Vasilikos
- Department of Neurosurgery, Medical Center and Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Center for Advanced Surgical Tissue Analysis (CAST), Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - P Kellmeyer
- Department of Neurosurgery, Medical Center and Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - C Scheiwe
- Department of Neurosurgery, Medical Center and Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - J H Klingler
- Department of Neurosurgery, Medical Center and Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - C Fung
- Department of Neurosurgery, Medical Center and Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - A Vlachos
- Department of Neuroanatomy, Institute of Anatomy and Cell Biology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Center for Advanced Surgical Tissue Analysis (CAST), Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Center Brain Links - Brain Tools, University of Freiburg, Freiburg, Germany
- Center for Basics in Neuromodulation (NeuroModulBasics), Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - J Beck
- Department of Neurosurgery, Medical Center and Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Center for Advanced Surgical Tissue Analysis (CAST), Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Center for Basics in Neuromodulation (NeuroModulBasics), Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - O Schnell
- Department of Neurosurgery, Medical Center and Faculty of Medicine, University of Freiburg, Freiburg, Germany.
- Center for Advanced Surgical Tissue Analysis (CAST), Faculty of Medicine, University of Freiburg, Freiburg, Germany.
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10
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Cutler CB, King P, Khan M, Olowofela B, Lucke-Wold B. Innovation in Neurosurgery: Lessons Learned, Obstacles, and Potential Funding Sources. NEURONS AND NEUROLOGICAL DISORDERS 2022; 1:003. [PMID: 36848305 PMCID: PMC9956204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
Innovation is central to neurosurgery and has dramatically increased over the last twenty years. Although the specialty innovates as a whole, only 3-4.7% of practicing neurosurgeons hold patents. Various roadblocks to innovation impede this process such as lack of understanding, increasing regulatory complexity, and lack of funding. Newly emerging technologies allow us to understand how to innovate and how to learn from other medical specialties. By further understanding the process of innovation, and the funding that supports it, Neurosurgery can continue to hold innovation as one of its's central tenets.
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Affiliation(s)
| | - Patrick King
- Rosalind Franklin University of Medicine and Science, Chicago, IL, USA
| | - Majid Khan
- University of Nevada, Reno School of Medicine, Reno, NV, USA
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11
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Bex A, Mathon B. Advances, technological innovations, and future prospects in stereotactic brain biopsies. Neurosurg Rev 2022; 46:5. [PMID: 36471144 PMCID: PMC9734929 DOI: 10.1007/s10143-022-01918-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Stereotactic brain biopsy is one of the most frequently performed brain surgeries. This review aimed to expose the latest cutting-edge and updated technologies and innovations available to neurosurgeons to safely perform stereotactic brain biopsy by minimizing the risks of complications and ensuring that the procedure is successful, leading to a histological diagnosis. We also examined methods for improving preoperative, intraoperative, and postoperative workflows. We performed a comprehensive state-of-the-art literature review. Intraoperative histology, fluorescence, and imaging techniques appear as smart tools to improve the diagnostic yield of biopsy. Constant innovations such as optical methods and augmented reality are also being made to increase patient safety. Robotics and integrated imaging techniques provide an enhanced intraoperative workflow. Patients' management algorithms based on early discharge after biopsy optimize the patient's personal experience and make the most efficient possible use of the available hospital resources. Many new trends are emerging, constantly improving patient care and safety, as well as surgical workflow. A parameter that must be considered is the cost-effectiveness of these devices and the possibility of using them on a daily basis. The decision to implement a new instrument in the surgical workflow should also be dependent on the number of procedures per year, the existing stereotactic equipment, and the experience of each center. Research on patients' postbiopsy management is another mandatory approach to enhance the safety profile of stereotactic brain biopsy and patient satisfaction, as well as to reduce healthcare costs.
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Affiliation(s)
- Alix Bex
- Department of Neurosurgery, CHR Citadelle, Liege, Belgium
| | - Bertrand Mathon
- Department of Neurosurgery, Sorbonne University, APHP, La Pitié-Salpêtrière Hospital, 47-83, Boulevard de L'Hôpital, 75651 Cedex 13, Paris, France.
- ICM, INSERM U 1127, CNRS UMR 7225, UMRS, Paris Brain Institute, Sorbonne University, 1127, Paris, France.
- GRC 23, Brain Machine Interface, APHP, Sorbonne University, Paris, France.
- GRC 33, Robotics and Surgical Innovation, APHP, Sorbonne University, Paris, France.
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12
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Wadiura LI, Kiesel B, Roetzer-Pejrimovsky T, Mischkulnig M, Vogel CC, Hainfellner JA, Matula C, Freudiger CW, Orringer DA, Wöhrer A, Roessler K, Widhalm G. Toward digital histopathological assessment in surgery for central nervous system tumors using stimulated Raman histology. Neurosurg Focus 2022; 53:E12. [PMID: 36455278 DOI: 10.3171/2022.9.focus22429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 09/19/2022] [Indexed: 12/03/2022]
Abstract
OBJECTIVE Intraoperative neuropathological assessment with conventional frozen sections supports the neurosurgeon in optimizing the surgical strategy. However, preparation and review of frozen sections can take as long as 45 minutes. Stimulated Raman histology (SRH) was introduced as a novel technique to provide rapid high-resolution digital images of unprocessed tissue samples directly in the operating room that are comparable to conventional histopathological images. Additionally, SRH images are simultaneously and easily accessible for neuropathological judgment. Recently, the first study showed promising results regarding the accuracy and feasibility of SRH compared with conventional histopathology. Thus, the aim of this study was to compare SRH with conventional H&E images and frozen sections in a large cohort of patients with different suspected central nervous system (CNS) tumors. METHODS The authors included patients who underwent resection or stereotactic biopsy of suspected CNS neoplasm, including brain and spinal tumors. Intraoperatively, tissue samples were safely collected and SRH analysis was performed directly in the operating room. To enable optimal comparison of SRH with H&E images and frozen sections, the authors created a digital databank that included images obtained with all 3 imaging modalities. Subsequently, 2 neuropathologists investigated the diagnostic accuracy, tumor cellularity, and presence of diagnostic histopathological characteristics (score 0 [not present] through 3 [excellent]) determined with SRH images and compared these data to those of H&E images and frozen sections, if available. RESULTS In total, 94 patients with various suspected CNS tumors were included, and the application of SRH directly in the operating room was feasible in all cases. The diagnostic accuracy based on SRH images was 99% when compared with the final histopathological diagnosis based on H&E images. Additionally, the same histopathological diagnosis was established in all SRH images (100%) when compared with that of the corresponding frozen sections. Moreover, the authors found a statistically significant correlation in tumor cellularity between SRH images and corresponding H&E images (p < 0.0005 and R = 0.867, Pearson correlation coefficient). Finally, excellent (score 3) or good (2) accordance between diagnostic histopathological characteristics and H&E images was present in 95% of cases. CONCLUSIONS The results of this retrospective analysis demonstrate the near-perfect diagnostic accuracy and capability of visualizing relevant histopathological characteristics with SRH compared with conventional H&E staining and frozen sections. Therefore, digital SRH histopathology seems especially useful for rapid intraoperative investigation to confirm the presence of diagnostic tumor tissue and the precise tumor entity, as well as to rapidly analyze multiple tissue biopsies from the suspected tumor margin. A real-time analysis comparing SRH images and conventional histological images at the time of surgery should be performed as the next step in future studies.
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Affiliation(s)
- Lisa I Wadiura
- 1Department of Neurosurgery, Medical University of Vienna, Austria
| | - Barbara Kiesel
- 1Department of Neurosurgery, Medical University of Vienna, Austria
| | - Thomas Roetzer-Pejrimovsky
- 2Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Austria
| | | | - Clemens C Vogel
- 1Department of Neurosurgery, Medical University of Vienna, Austria
| | - Johannes A Hainfellner
- 2Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Austria
| | - Christian Matula
- 1Department of Neurosurgery, Medical University of Vienna, Austria
| | | | - Daniel A Orringer
- 4Department of Neurosurgery, New York University, New York, New York
| | - Adelheid Wöhrer
- 2Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Austria
| | - Karl Roessler
- 1Department of Neurosurgery, Medical University of Vienna, Austria
| | - Georg Widhalm
- 1Department of Neurosurgery, Medical University of Vienna, Austria
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13
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Surgical Treatment of Glioblastoma: State-of-the-Art and Future Trends. J Clin Med 2022; 11:jcm11185354. [PMID: 36143001 PMCID: PMC9505564 DOI: 10.3390/jcm11185354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 08/17/2022] [Accepted: 08/31/2022] [Indexed: 11/22/2022] Open
Abstract
Glioblastoma (GBM) is a highly aggressive disease and is associated with poor prognosis despite treatment advances in recent years. Surgical resection of tumor remains the main therapeutic option when approaching these patients, especially when combined with adjuvant radiochemotherapy. In the present study, we conducted a comprehensive literature review on the state-of-the-art and future trends of the surgical treatment of GBM, emphasizing topics that have been the object of recent study.
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14
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Neidert N, Straehle J, Erny D, Sacalean V, El Rahal A, Steybe D, Schmelzeisen R, Vlachos A, Reinacher PC, Coenen VA, Mizaikoff B, Heiland DH, Prinz M, Beck J, Schnell O. Stimulated Raman histology in the neurosurgical workflow of a major European neurosurgical center - part A. Neurosurg Rev 2021; 45:1731-1739. [PMID: 34914024 PMCID: PMC8976801 DOI: 10.1007/s10143-021-01712-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/22/2021] [Accepted: 11/26/2021] [Indexed: 12/02/2022]
Abstract
Histopathological diagnosis is the current standard for the classification of brain and spine tumors. Raman spectroscopy has been reported to allow fast and easy intraoperative tissue analysis. Here, we report data on the intraoperative implementation of a stimulated Raman histology (SRH) as an innovative strategy offering intraoperative near real-time histopathological analysis. A total of 429 SRH images from 108 patients were generated and analyzed by using a Raman imaging system (Invenio Imaging Inc.). We aimed at establishing a dedicated workflow for SRH serving as an intraoperative diagnostic, research, and quality control tool in the neurosurgical operating room (OR). First experiences with this novel imaging modality were reported and analyzed suggesting process optimization regarding tissue collection, preparation, and imaging. The Raman imaging system was rapidly integrated into the surgical workflow of a large neurosurgical center. Within a few minutes of connecting the device, the first high-quality images could be acquired in a “plug-and-play” manner. We did not encounter relevant obstacles and the learning curve was steep. However, certain prerequisites regarding quality and acquisition of tissue samples, data processing and interpretation, and high throughput adaptions must be considered. Intraoperative SRH can easily be integrated into the workflow of neurosurgical tumor resection. Considering few process optimizations that can be implemented rapidly, high-quality images can be obtained near real time. Hence, we propose SRH as a complementary tool for the diagnosis of tumor entity, analysis of tumor infiltration zones, online quality and safety control and as a research tool in the neurosurgical OR.
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Affiliation(s)
- Nicolas Neidert
- Department of Neurosurgery, Medical Center, University of Freiburg, Freiburg, Germany.,Microenvironment and Immunology Research Laboratory, Medical Center, University of Freiburg, Freiburg, Germany
| | - Jakob Straehle
- Department of Neurosurgery, Medical Center, University of Freiburg, Freiburg, Germany
| | - Daniel Erny
- Institute of Neuropathology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Vlad Sacalean
- Department of Neurosurgery, Medical Center, University of Freiburg, Freiburg, Germany.,Microenvironment and Immunology Research Laboratory, Medical Center, University of Freiburg, Freiburg, Germany
| | - Amir El Rahal
- Department of Neurosurgery, Medical Center, University of Freiburg, Freiburg, Germany
| | - David Steybe
- Department of Oral and Maxillofacial Surgery, Medical Center, University of Freiburg, Freiburg, Germany
| | - Rainer Schmelzeisen
- Department of Oral and Maxillofacial Surgery, Medical Center, University of Freiburg, Freiburg, Germany.,Medical Faculty, Freiburg University, Freiburg, Germany
| | - Andreas Vlachos
- Medical Faculty, Freiburg University, Freiburg, Germany.,Department of Neuroanatomy, Institute of Anatomy and Cell Biology, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Center for Basics in NeuroModulation (NeuroModulBasics), Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Center Brain Links Brain Tools, University of Freiburg, Freiburg, Germany
| | - Peter Christoph Reinacher
- Medical Faculty, Freiburg University, Freiburg, Germany.,Department of Stereotactic and Functional Neurosurgery, Medical Center, University of Freiburg, Freiburg, Germany.,Fraunhofer Institute for Laser Technology (ILT), Aachen, Germany
| | - Volker Arnd Coenen
- Medical Faculty, Freiburg University, Freiburg, Germany.,Department of Stereotactic and Functional Neurosurgery, Medical Center, University of Freiburg, Freiburg, Germany
| | - Boris Mizaikoff
- Institute of Analytical and Bioanalytical Chemistry, Ulm University, Ulm, Germany.,Hahn-Schickard Institute for Microanalysis Systems, Ulm, Germany
| | - Dieter Henrik Heiland
- Department of Neurosurgery, Medical Center, University of Freiburg, Freiburg, Germany.,Microenvironment and Immunology Research Laboratory, Medical Center, University of Freiburg, Freiburg, Germany.,Medical Faculty, Freiburg University, Freiburg, Germany.,Comprehensive Cancer Center Freiburg (CCCF), Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany.,German Cancer Consortium (DKTK), partner site Freiburg, Freiburg, Germany
| | - Marco Prinz
- Institute of Neuropathology, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Medical Faculty, Freiburg University, Freiburg, Germany.,Center for Basics in NeuroModulation (NeuroModulBasics), Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Signalling Research Centres BIOSS and CIBSS, University of Freiburg, Freiburg, Germany
| | - Jürgen Beck
- Department of Neurosurgery, Medical Center, University of Freiburg, Freiburg, Germany.,Medical Faculty, Freiburg University, Freiburg, Germany.,Center for Basics in NeuroModulation (NeuroModulBasics), Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Comprehensive Cancer Center Freiburg (CCCF), Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Oliver Schnell
- Department of Neurosurgery, Medical Center, University of Freiburg, Freiburg, Germany. .,Medical Faculty, Freiburg University, Freiburg, Germany.
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