Optical Biopsy of Peripheral Nerve Using Confocal Laser Endomicroscopy: A New Tool for Nerve Surgeons?

Peripheral nerve injuries remain a challenge for reconstructive surgeons with many patients obtaining suboptimal results. Understanding the level of injury is imperative for successful repair. Current methods for distinguishing healthy from damaged nerve are time consuming and possess limited efficacy. Confocal laser endomicroscopy (CLE) is an emerging optical biopsy technology that enables dynamic, high resolution, sub-surface imaging of live tissue. Porcine sciatic nerve was either left undamaged or briefly clamped to simulate injury. Diluted fluorescein was applied topically to the nerve. CLE imaging was performed by direct contact of the probe with nerve tissue. Images representative of both damaged and undamaged nerve fibers were collected and compared to routine H&E histology. Optical biopsy of undamaged nerve revealed bands of longitudinal nerve fibers, distinct from surrounding adipose and connective tissue. When damaged, these bands appear truncated and terminate in blebs of opacity. H&E staining revealed similar features in damaged nerve fibers. These results prompt development of a protocol for imaging peripheral nerves intraoperatively. To this end, improving surgeons' ability to understand the level of injury through real-time imaging will allow for faster and more informed operative decisions than the current standard permits.

Keywords

Trauma, nervous system - Microscopy - Biopsy - Diagnostic imaging - Histological techniques

Publication History

Received: 27 April 2015

Accepted: 19 June 2015

Article published online:
05 May 2022

• References

• 1 Lundborg G. A 25-year perspective of peripheral nerve surgery: evolving neuroscientific concepts and clinical significance. J Hand Surg Am 2000; 25: 391-414
• 2 Sunderland S. Nerve injuries and their repair: a critical appraisal. Edinburgh: Churchill Livingstone; 1991
• 3 Meining A. Confocal endomicroscopy. Gastrointest Endosc Clin N Am 2009; 19: 629-635
• 4 Kiesslich R, Burg J, Vieth M. et al. Confocal laser endoscopy for diagnosing intraepithelial neoplasias and colorectal cancer in vivo. Gastroenterology 2004; 127: 706-713
• 5 Wang TD, Friedland S, Sahbaie P. et al. Functional imaging of colonic mucosa with a fibered confocal microscope for real-time in vivo pathology. Clin Gastroenterol Hepatol 2007; 5: 1300-1305
• 6 Gomez V, Buchner AM, Dekker E. et al. Interobserver agreement and accuracy among international experts with probe-based confocal laser endomicroscopy in predicting colorectal neoplasia. Endoscopy 2010; 42: 286-291
• 7 Banno K, Niwa Y, Miyahara R. et al. Confocal endomicroscopy for phenotypic diagnosis of gastric cancer. J Gastroenterol Hepatol 2010; 25: 712-718
• 8 Li WB, Zuo XL, Zuo F. et al. Characterization and identification of gastric hyperplastic polyps and adenomas by confocal laser endomicroscopy. Surg Endosc 2010; 24: 517-524
• 9 Dunbar KB, Okolo 3rd P, Montgomery E. et al. Confocal laser endomicroscopy in Barrett's esophagus and endoscopically inapparent Barrett's neoplasia: a prospective, randomized, double-blind, controlled, crossover trial. Gastrointest Endosc 2009; 70: 645-654
• 10 Pech O, Rabenstein T, Manner H. et al. Confocal laser endomicroscopy for in vivo diagnosis of early squamous cell carcinoma in the esophagus. Clin Gastroenterol Hepatol 2008; 6: 89-94
• 11 Kiesslich R, Gossner L, Goetz M. et al. In vivo histology of Barrett's esophagus and associated neoplasia by confocal laser endomicroscopy. Clin Gastroenterol Hepatol 2006; 4: 979-987
• 12 Wu K, Liu JJ, Adams W. et al. Dynamic real-time microscopy of the urinary tract using confocal laser endomicroscopy. Urology 2011; 78: 225-231