Microscopy Solutions for Neuropathology

Neuropathology is a branch of pathology that focuses on the diagnosis and research of diseases of the brain and of the nervous system. Diagnoses are necessary for individual patient treatment or for forensic requests and are typically based on the microscopic and molecular analysis of neurosurgically extracted tissue samples. Common fields of study are tumors and diseases within the central nervous system (CNS) such as glioblastomas, neurodegenerative changes, and various developmental brain disorders.

Neuropathologists as physicians play an important role in the treatment of patients, for example with a brain tumor, because the result of the neuropathological analysis is a key element for the diagnosis. After the diagnosis is made, neurosurgeons and neurooncologists decide together in a tumor board review about the personalized therapy.

In neurosurgery, imaging techniques with contrast agents are increasingly used to improve intraoperative decision-making.1 Typically, these systems are aimed at macroscopic visualization of fluorescent areas and rely on surgical microscopes which are equipped with appropriate filters and light sources.1 For confocal endomicroscopy (CEM),2 this technique has been refined to visualize the microstructure of tissue at high magnification. It delivers images in real time and in vivo, i.e. without the need to extract tissue.1 In CEM a scanner probe (resembling a rigid endoscope) gently contacts the tissue surface in order to reveal cellular and architectural detail at the subsurface level based on a fluorescent agent.1

1 Leierseder S. Confocal Endomicroscopy during brain surgery. Laser+Phtonics 2018. Available at: https://www.photonik.de/confocal-endomicroscopy-during-brain-surgery/150/21404/363684 [Accessed 2 April 2020].
2 An equivalent expression that is frequently used is “confocal laser endomicroscopy” (CLE).

Experimental glioma in mice (in vivo) using intravenously fluorescein sodium.

Matched CONVIVO image

Experimental glioma in mice (in vivo) using intravenously fluorescein sodium. Matched CONVIVO image.
Image courtesy of Dr. Mark C. Preul and Dr. Evgenii Belykh (Barrow Neurological Institute Neurosurgery Research Laboratory)

 H&E stained section

Experimental glioma in mice (in vivo) using intravenously fluorescein sodium. H&E stained section
Image courtesy of Dr. Mark C. Preul and Dr. Evgenii Belykh (Barrow Neurological Institute Neurosurgery Research Laboratory)