Innovative Imaging Techniques for Neurosurgical Guidance
Micro neurosurgery remains an exceedingly demanding and dexterous fine motor task. Microscope integrated three dimensional imaging techniques which delineate the microstructural composition in depth are missing so far.
A: Light microscopic image after right fronto-lateral craniotomy, during dissection of dura mater. Opened segment shows sylvian fissure with superficial sylvian veins and temporal as well as frontal brain cortex. Orange line indicates region of scan. B: OCT-scan of dura mater depicting the (1) outer endosteal and (2) inner meningeal layer. Strikingly, a (3) subdural space is present, enabling a clear definition of (2) the inner meningeal dural layer and the (4) arachnoid barrier cell membrane. Furthermore, (5) subarachnoid blood vessels, (6) subarachnoid space, (7) trabecular system, (8) brain cortex and (9) reflection artifacts are depicted by the transdural OCT scan. C: Light microscopic image after dural opening depicting the frontal brain cortex, sylvian fissure and temporal brain cortex. Red line indicates the area of enlarged excerpt. D: Enlarged excerpt demonstrating details of transdural OCT scan. E: Schematic drawing of microstructures: (1) + (2) dura mater, (1) outer endosteal layer, (2) inner meningeal layer, (3) subdural space, (4) subarachnoid space (4) arachnoid barrier cell membrane, (5) subarachnoid blood vessels, (6) subarachnoid space, (7) trabecular system, (8) brain cortex and (9) reflection artifacts.
OCT imaging depends on the detection of back scattered near infrared light and is therefore harmless to biological tissue [1]. Its physical properties allow for microscope integration [2]. This leads to the possibility of contact free three-dimensional, real-time scanning of tissue in the field of view of the surgeon [3]. Penetrating depth depends on optical tissue densities. With approximately 4000 μm in the human cerebral cortex it meets microsurgical requirements [4].
In particular OCT offers an unprecedented axial spatial resolution ranging from 1 - 15 μm –approaching the resolution of conventional histopathology [5]. In vitro recent optical and image processing advancements like automatic serial sectioning of polarization sensitive OCT (asPSOCT) and speckle modulation further increased image quality to display cerebral cortical layers at single cell width [6] [7] [8].
A part from structural imaging adaptations of perfusion-dependent OCT offer the possibility of parallel functional brain mapping [9] [10] [11].Due to the capability of performing “optic biopsies” systems which combine catheter integrated OCT and laser ablation might demonstrate minimal invasive and precise theranostic instruments [12]-[15].
These versatile strengths shed light on future perspectives. Our team validates intraoperative use of microscope integrated OCT for progression of neurosurgical guidance.
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