ArticleJournal of neurosurgery. Case lessons2026
Real-time intraoperative confocal laser endomicroscopy with on-site neuropathologist consultation for glioma margin assessment: illustrative case.
Article in Journal of neurosurgery. Case lessons, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundAchieving maximal safe resection in glioma surgery requires accurate real-time margin assessment, yet existing technologies have limitations. Fluorescence-guided surgery shows limitations at infiltrative margins, while frozen section analysis requires 20-45 minutes per specimen. Confocal laser endomicroscopy (CLE) is an emerging in vivo imaging technology that enables real-time cellular-resolution tissue examination in situ. OBSERVATIONS: The authors present a case demonstrating integration of CLE with on-site neuropathologist collaboration for real-time intraoperative diagnosis. A 53-year-old woman with left frontotemporal high-grade glioma underwent surgery with systematic examination of five locations using CLE. The collaborative workflow enabled rapid tissue assessment (mean 95 seconds per site) with immediate expert interpretation. Critically, high-grade glioma was detected at a site with complete absence of 5-aminolevulinic acid fluorescence (spot 4), demonstrating CLE's capability to identify tumor infiltration beyond fluorescence-guided boundaries and enabling extended resection. LESSONS: Integrating CLE with on-site pathologist consultation creates an effective paradigm for real-time margin assessment, addressing the 30%-40% false-negative rate of fluorescence guidance. This collaborative approach is immediately implementable at centers with neuropathology expertise and establishes a foundation for future telepathology and artificial intelligence-assisted diagnostic platforms. https://thejns.org/doi/10.3171/CASE25890.
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