Intraoperative confocal laser endomicroscopy for interpretation of a sellar hemangioblastoma: illustrative case

被引:0
|
作者
Abramov, Irakliy [1 ]
Furey, Charuta G. [2 ]
Xu, Yuan [1 ]
Eschbacher, Jennifer M. [3 ]
Smith, Kris A. [2 ]
Preul, Mark C. [1 ]
机构
[1] St Josephs Hosp, Barrow Neurol Inst, Dept Neurosurg, Loyal & Edith Davis Neurosurg Res Lab, Phoenix, AZ 85013 USA
[2] Barrow Neurol Inst, St Josephs Hosp & Med Ctr, Dept Neurosurg, Phoenix, AZ USA
[3] Barrow Neurol Inst, St Josephs Hosp & Med Ctr, Dept Neuropathol, Phoenix, AZ USA
来源
JOURNAL OF NEUROSURGERY-CASE LESSONS | 2023年 / 6卷 / 12期
关键词
confocal laser endomicroscopy; hemangioblastoma; intraoperative diagnosis; telemedicine; PATHOLOGY; FEATURES;
D O I
10.3171/CASE23417
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
BACKGROUND Intraoperative frozen sections play a critical role in surgical strategy because of their ability to provide rapid histopathological information. In cases in which intraoperative biopsy carries a significant risk of bleeding, intraoperative confocal laser endomicroscopy (CLE) can assist in decision-making. OBSERVATIONS The authors present a rare case of a large sellar hemangioblastoma. Preoperative radiographic imaging and normal pituitary function suggested a differential diagnosis that included hemangioblastoma. The patient underwent partial preoperative embolization and a right-sided pterional craniotomy for resection of the lesion. Gross intraoperative examination revealed a highly vascular sellar lesion requiring circumferential dissection to minimize blood loss. The serious vascularity precluded intraoperative frozen section analysis, and CLE imaging was performed. CLE imaging provided excellent visualization of the remarkable vascular structure and characteristic histoarchitecture with microvasculature, intracytoplasmic vacuoles, and atypical cells consistent with hemangioblastoma. Resection and decompression of the chiasm was accomplished, and the patient was discharged with improved vision. The final histopathological diagnosis was hemangioblastoma. LESSONS When the benefits of obtaining intraoperative frozen sections greatly outweigh the associated risks, CLE imaging can aid in decisionmaking. CLE imaging offers real-time, on-the-fly evaluation of intraoperative tissue without the need to biopsy a vascular lesion.
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页数:5
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