Abstract

Intraoperative fluorescence-imaging of nerves - a contribution to navigation surgery

Author(s): Akio Sugitachi*, Koki Otsuka, Fumitaka Endo, Toshimoto Kimura, Takeshi Takahara, Yuji Akiyama, Takeshi Iwaya, Hiroyuki Nitta, Keisuke Koeda, Masaru Mizuno & Akira Sasaki

Nerve-preservation technique plays an important role in surgery. Intraoperative nerve injuries often cause permanent neurogenic untoward events such as functional disorders, palsy, pain and numbness. To avoid such accidents, we devised an intraoperative fluorescence-imaging of peripheral nerves as a contribution to navigation surgery. Myelin-targeting fluorescent agents; namely, amphotericin B and fluorescinisothyanate, were used as markers of nerves in this study since myelin was a main component of Schwann sheath in peripheral nerve. In in vitro, cultured Schwann cells were served as model of peripheral nerves. After treating Schwann cells with each fluorescent agent, we observed the fluorescence emitted in a dark room. Then, we carried out in vivo studies with rats following the results of in vitro data and assessed the clinical significance of our newly devised method. We could clearly observe specific florescence the Schwann cells radiated in in vitro and discriminated peripheral nerve fibres from surrounding tissues in in vivo. These results strongly suggested a clinical usefulness of intraoperative visualization of peripheral nerve fibres. Our novel method would promote intraoperative nerve- preservation.