Confocal Neurolasermicroscopy - Modern Perspectives for Glioma Resection on a Cellular Level

Confocal neurolasermicroscopy (NLM)(Schlosser et al., 2009 (Epub)) is the current front end of the innovative process in neurosurgery for optimizing the operative results. Hence NLM is the continuance of a protracted development. Microscopic imaging technologies in neurosurgery invented 50 years ago revealed new strategies and possibilities for surgeons. These techniques were first used with magnifying lenses in research for introducing blood into the subarachnoid space in the region of circle of Willis in dog (Lougheed and Tom, 1961). It was further used in cerebrovascular diseases (Jacobson et al., 1962) (Chou, 1963), graft interposition (Woringer and Kunlin, 1963) (Lougheed et al., 1971) and aneurysm surgery (Pool and Colton, 1966) (Rand and Jannetta, 1967). From studies assessing radical surgery in the excision of fluorescence labelled tumours (Stummer et al., 2006) (Stummer et al., 1998) the necessity for a high-resolution imaging technique was clearly evident. Intravital fluorescence microscopy was used in animal studies to investigate tumorangiogenesis and microcirculation (Read et al., 2001) (Vajkoczy et al., 2000). In the following section our pilot study using NLM in the neurosurgical operating condition is introduced (Schlosser et al., 2009 (Epub)). We aimed to demonstrate a technique with the potential to be adapted intraoperatively to define cellular and subcellular structures during ongoing neurosurgery. Here we show our results of miniaturized confocal lasermicroscopy in normal brain and brain tumor tissue which we termed NLM. Our pilot study was initiated to test the feasibility of this new technique and to open the door for high resolution imaging during ongoing neurosurgery.