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. 2022 Nov 4;12(11):2697. doi: 10.3390/diagnostics12112697

Table 1.

Intraoperative use of CLE in neurosurgery.

Name of the Study Date Author Number of
Patients 		Stain Used Results
Laser-Scanning Confocal Endomicroscopy (LSCE) in the Neurosurgical Operating Room: a review and Discussion of future applications 2011 Sanai, N. [16] 10 Fluorescein
5-ALA
  • -

    There are technical limitations in visualization. Specifically, in regard to the identification of nuclear morphology, cytoplasm characteristics and nuclear-to-cell ratios
Comparing High-Resolution Microscopy Techniques for Potential Intraoperative use in Guided Low-Grade Glioma Resections 2015 Meza, D. [26] 7 5-ALA
  • -

    Out of the three techniques investigated, only DAC microscopy was able to offer high image resolution comparable to histology

  • -

    Disadvantage of DAC: requires a laser-scanning mechanism to achieve sectioning
Confocal Laser Endomicroscopy for Real-time Histomorphological Diagnosis: Our Clinical Experience with 150 Brain and Spinal Tumor Cases 2015 Charalampaki, P. [17] 150 Acriflavine, Fluorescein
  • -

    Key features of different types of brain and spinal tumors were observed

  • -

    CLE offered benefits for patients, neurosurgeons and other oncological disciplines

  • -

    In general, waiting times for histopathological review have been greatly reduced using CLE
Intraoperative Probe-Based Confocal Laser Endomicroscopy in Surgery and Stereotactic Biopsy of Low-Grade and High-Grade Gliomas: A Feasibility Study in Humans 2016 Pavlov, V. [19] 9 5- ALA (3)
FNa (6)
  • -

    Cellvizio allowed for successful differentiation between healthy and pathological tissue

  • -

    The intraoperative dyes do not pose any intraoperative risks

  • -

    Fluorescence allows better differentiation between tissue types
Prospective Evaluation of the Utility of Intraoperative Confocal Laser Endomicroscopy in Patients with Brain Neoplasms using Fluorescein Sodium: Experience with 74 Cases 2016 Martirosyan, NL. [27] 74 FNa
  • -

    Mean duration of intraoperative CLE was approximately 16 min

  • -

    Glioma specificity and sensitivity were 94% and 91%

  • -

    Meningioma specificity and sensitivity were 93% and 97%

  • -

    CLE could allow for interactive identification of tumor areas and improve tumor resection
Visualization of Brain Microvasculature and Blood flow in Vivo : Feasibility Study using Confocal Laser Endomicroscopy 2021 Belykh, E. [28] 20 FNa
  • -

    CLE allows for precise details of real-time cell movements.

  • -

    CLE allowed for classification of the microvasculature in gliomas into normal and abnormal.

  • -

    Microvasculature was visible for up to 30 min after 2 mg application.
Probe-Based Three-Dimensional Confocal Laser Endomicroscopy of Brain Tumors: Technical Note 2018 Belykh, E. [29] Mice: 19
Patients: 31		 FNa
  • -

    3D-rendered images allow an increased spatial understanding of cellular architecture and structures
Confocal-Assisted Multispectral Fluorescent Microscopy for Brain Tumor Surgery 2019 Charalampaki, P. [23] Rats: 22
Patients: 13		 ICG
  • -

    Optimizing microsurgery by improving its safety and efficiency is an important aspect of oncological neurosurgery

  • -

    There are different techniques that are being investigated in order to determine the best approach

  • -

    A technique of importance is the use of ICG and CLE to help contrast tumors and tumor margins

  • -

    There are still limitations to overcome; however, CLE proves promising
Intraoperative Confocal Laser Endomicroscopy Ex Vivo Examination of Tissue Microstructure During Fluorescence-Guided Brain Tumor Surgery 2020 Belykh, E. [30] 47 FNa
  • -

    Specificity of CLE: 90%

  • -

    Diagnostic features were able to be identified and allowed for a distinction between healthy brain tissue and lesional gliomas
Ex Vivo Fluorescein-Assisted Confocal Laser Endomicroscopy (CONVIVO System) in Patients with Glioblastoma: Results from a Prospective Study 2020 Acerbi, F. [20] 15 FNa
  • -

    Blind comparison between CONVIVO-Zeiss and frozen image showed a high correlation of correct diagnosis.

  • -

    CLE can be used as a complementary tool for intraoperative diagnosis during glioblastoma surgery
Intraoperative Imaging of Brain Tumors with Fluorescein: Confocal Laser Endomicroscopy in Neurosurgery. Clinical and User experience 2021 Höhne, J. [31] 12 FNa
  • -

    CLE allowed high-quality visualization of fine structures, anatomical details and microstructures.

  • -

    Comparative validation from neuropathologists is crucial for CLE success
Intraoperative Confocal Laser Endomicroscopy: Prospective in Vivo Feasibility Study of a Clinical-Grade System for Brain Tumors 2022 Abramov, I. [32] 30 FNa
  • -

    Interpretable CLE results were attained in 7 min

  • -

    Positive correlation between interpretable image acquisition and surgeon experience, cumulative length of CLE time and CLE time per case

  • -

    Accuracy, sensitivity and specificity were at 94%, 94%, and 100%, respectively

  • -

    The safety and feasibility of obtaining noninvasive biopsy results were proven successful
Real-Time Intraoperative Surgical Telepathology using Confocal Laser Endomicroscopy 2022 Abramov, I. [33] 11 FNa
  • -

    CLE identification has proven to be faster than neuropathological analysis (6 min vs. 23 min)

  • -

    CLE does not only allow quicker analysis but also allows a less invasive approach to pathology by allowing pathologists to view the images simultaneously with the surgeons

CLE: confocal laser endomicroscopy; FNa: sodium fluorescein; 5-ALA: aminolevulinic acid; GFP: green fluorescent protein; MG: magnifying glasses; DAC: dual-axis confocal microscopy.