Endonasal confocal laser rndomicroscopy – real-time characterization and differentiation of malignancies of the nasal cavity, the paranasal sinuses and skull base

Introduction Endonasal and skull base tumors are challenging due to the complex anatomy and histological heterogeneity. Real-time assessment of tumor margins during resection can support intraoperative decision making. Confocal Laser Endomicroscopy (CLE) has emerged as a valuable tool for in vivo tissue imaging. In this study, we aimed to investigate not only the utility of CLE in examination of tumor margins but also to differentiate between different entities of endonasal malignancies.

Material and Methods We used CLE in endoscopic-endonasal resection of 8 tumors including 4 squamous cell carcinomas, 2 adenocarcinomas and 2 mucosal malignant melanomas. Intraoperatively, CLE imaging was performed to visualize tumor characteristics and surrounding tissue. The CLE images were correlated with histopathological examination for validation and establish identification criteria for the different entities.

Results CLE imaging provided real-time insights into tumor characteristics, enabling differentiation between the malignancies examined. Distinct features such as cellular morphology, microvascular patterns and extracellular matrix alterations were visualized. The imaging allowed for identification of tumor margins, aiding in complete resection while preserving healthy tissue.

Conclusion CLE is a promising tool for advanced real-time examination of endonasal and skull base tumors during resection. It offers the ability to not only to define tumor margins but to differentiate between different tumor entities. The technology's real-time imaging capabilities may enhance surgical decision-making and improve patient outcomes by allowing for more accurate and tailored tumor resections.

Funding information Stiftung Tumorforschung Kopf-Hals

Publication History

Article published online:
19 April 2024