EndoSCell: A portable intraoperative histopathological microscopy device for enhanced glioma resection and prognosis in animal models

Safe maximal resection remains a critical goal and prognostic factor in glioma treatment. Neurosurgeons face significant challenges in accurately identifying the true extent of glioma during surgery due to its highly infiltrative nature. Currently, there are no tools available that allow for real-time, <i>in vivo</i> observation of surgical margins. This study introduces EndoSCell, a portable, anti-shake intraoperative histopathological microscopy device designed to overcome these limitations. EndoSCell is resistant to vibrations typical in the operating room and can be used to accurately identify the margins of malignant gliomas (MG) during surgery. The effectiveness of EndoSCell was assessed through <i>ex vivo</i> neuropathological analysis of tumor and brain tissues from glioblastoma patients, as well as <i>in vivo</i> analysis using 9L glioma and patient-derived tumor xenograft models. Craniectomies were performed on 9L orthotopic glioma-xenograft rat models with or without EndoSCell assistance, conducted by two different neurosurgeons. EndoSCell successfully demarcated the invasive margins of tumor xenografts. Postoperative magnetic resonance imaging and pathological examinations confirmed its ability to delineate tumor margins effectively. Both <i>ex vivo</i> and <i>in vivo</i> analyses showed that EndoSCell distinguishes tumor cells from normal brain cells with high precision. These findings demonstrate that EndoSCell-guided surgery not only achieves negative margins but also significantly reduces tumor recurrence, substantially improving survival rates (86% vs 20%; <i>P</i> < 0.001) in MG-bearing rats. This technology enables more precise and complete tumor resections, thereby improving progression-free survival in glioma-xenograft models.