Endonasal Confocal Laser Endomicroscopy: Real-Time Characterization and Differentiation of Endonasal and Skull Base Malignancies

Introduction: The complex anatomy and histological diversity of endonasal and skull base tumors present significant challenges. Intraoperative decision-making benefits from real-time assessment of tumor margins during resection. Confocal Laser Endomicroscopy (CLE) has emerged as a valuable in vivo tissue imaging tool on a cellular level. Our study's focus was to explore the utility of CLE, not only in examining tumor margins but also in distinguishing between various entities of endonasal malignancies.

Methods: CLE was employed during endoscopic-endonasal resection of various endonasal tumors (squamous cell carcinoma, adenocarcinoma, and sinunasal mucosal malignant melanoma). Its intraoperative use aimed to visualize both tumor characteristics and the adjacent tissue. Correlation between the CLE images and histopathological examination was conducted to validate and establish identification criteria for these distinct entities.

Results: Real-time insights into tumor characteristics were facilitated by CLE imaging, allowing differentiation between the examined malignancies. Visualization of features like cellular morphology, microvascular patterns, and alterations in the extracellular matrix was made possible. This imaging technique aided in the identification of tumor margins, enabling complete resection while also preserving adjacent healthy tissue.

Conclusions: The use of CLE presents a promising advancement in the real-time examination of endonasal and skull base tumors during resection. Its capabilities extend beyond defining tumor margins, enabling the differentiation between various tumor entities. With its real-time imaging technology, CLE has the potential to elevate surgical decision-making, facilitating more precise and personalized tumor resections that may lead to improved patient outcomes.