Real-time image-guided direct convective perfusion of intrinsic brainstem lesions
| Autor: | Edward H. Oldfield, David Croteau, R. Aaron Robison, Marion L. Walker, Russell R. Lonser, Raphael Schiffman, Marsha J. Merrill, Roscoe O. Brady, Katherine E. Warren, Deric M. Park, John A. Butman, Stuart Walbridge, Zenaide M.N. Quezado |
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| Rok vydání: | 2007 |
| Předmět: |
Gadolinium DTPA
Male Pathology medicine.medical_specialty Facial Paralysis Contrast Media Neurosurgical Procedures Central nervous system disease Catheters Indwelling Pons Glioma medicine Humans Distribution (pharmacology) Cerebellar Neoplasms Gaucher Disease Intraoperative Care medicine.diagnostic_test business.industry Infant Newborn Magnetic resonance imaging medicine.disease Magnetic Resonance Imaging Cannula Perfusion Surgery Computer-Assisted Cerebrovascular Circulation Drug delivery Brainstem Radiology business Brain Stem |
| Zdroj: | Journal of Neurosurgery. 107:190-197 |
| ISSN: | 0022-3085 |
| DOI: | 10.3171/jns-07/07/0190 |
| Popis: | ✓Recent preclinical studies have demonstrated that convection-enhanced delivery (CED) can be used to perfuse the brain and brainstem with therapeutic agents while simultaneously tracking their distribution using coinfusion of a surrogate magnetic resonance (MR) imaging tracer. The authors describe a technique for the successful clinical application of this drug delivery and monitoring paradigm to the brainstem. Two patients with progressive intrinsic brainstem lesions (one with Type 2 Gaucher disease and one with a diffuse pontine glioma) were treated with CED of putative therapeutic agents mixed with Gd–diethylenetriamene pentaacetic acid (DTPA). Both patients underwent frameless stereotactic placement of MR imaging–compatible outer guide–inner infusion cannulae. Using intraoperative MR imaging, accurate cannula placement was confirmed and real-time imaging during infusion clearly demonstrated progressive filling of the targeted region with the drug and Gd-DTPA infusate. Neither patient had clinical or imaging evidence of short- or long-term infusate-related toxicity. Using this technique, CED can be used to safely perfuse targeted regions of diseased brainstem with therapeutic agents. Coinfused imaging surrogate tracers can be used to monitor and control the distribution of therapeutic agents in vivo. Patients with a variety of intrinsic brainstem and other central nervous system disorders may benefit from a similar treatment paradigm. |
| Databáze: | OpenAIRE |
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