Arch Plast Surg.  2015 Sep;42(5):626-629. 10.5999/aps.2015.42.5.626.

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

• Crowe CS
• Liao JC
• Curtin CM

• KMID: 2391880
• DOI: http://doi.org/10.5999/aps.2015.42.5.626

Abstract

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.

Keyword

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

MeSH Terms

Biopsy*
Blister
Connective Tissue
Diagnostic Imaging
Fluorescein
Histological Techniques
Humans
Microscopy
Nerve Fibers
Nerve Tissue
Peripheral Nerve Injuries
Peripheral Nerves*
Sciatic Nerve
Trauma, Nervous System
Fluorescein