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Cureus Sep 2021The literature is rich with many studies reporting different treatment modalities and approaches for cystic craniopharyngioma (CC), including microsurgery,...
The literature is rich with many studies reporting different treatment modalities and approaches for cystic craniopharyngioma (CC), including microsurgery, neuroendoscopic transventricular approach, endoscopic transnasal surgery, stereotactic drainage, and Ommaya reservoir insertion. The goals of this manuscript are to report the successful treatment of an atypical case of CC using the neuroendoscopic transventricular approach (NTVA) as well as discuss the different surgical modalities for these tumors following a comprehensive review of the literature. Our patient is a nine-year-old female with a large CC who was managed using the NTVA. No complications or recurrence occurred over two years of follow-up. Results of our literature review showed lower recurrence and complication rates of the NTVA compared to other surgical modalities.The NTVA is potentially efficient, reliable, and safe for managing CC and cystic-dominant craniopharyngiomas, with low recurrence and complication rates compared to microsurgery and Ommaya reservoir insertion. Future randomized clinical studies comparing the various treatment modalities of CC are needed to solidify these conclusions.
PubMed: 34692333
DOI: 10.7759/cureus.18123 -
Arquivos de Neuro-psiquiatria Sep 2021Intrathecal chemotherapy is a local therapeutic modality used for treatment of leptomeningeal metastases. However, the techniques currently used, i.e. repeated lumbar...
BACKGROUND
Intrathecal chemotherapy is a local therapeutic modality used for treatment of leptomeningeal metastases. However, the techniques currently used, i.e. repeated lumbar puncture and Ommaya reservoir, have certain disadvantages. Lumbar intrathecal port (LIP) placement is a relatively novel technique, which has been used for pain management in cancer patients.
OBJECTIVE
To investigate the use of LIP for intrathecal administration of chemotherapeutic agents in patients with leptomeningeal metastases.
METHODS
Retrospective study of 13 patients treated with intrathecal chemotherapy for secondary leptomeningeal involvement of a primary solid tumor were included in this retrospective study. The patients received intrathecal chemotherapy through a LIP.
RESULTS
The patients received a total of 123 intrathecal chemotherapy doses. No grade 3-4 toxicity, technical problem or severe complication developed. During a median of 136 days of follow-up (range, 67-376 days), 12 patients died (92.3%). The treatment resulted in symptom improvement in all patients and self-rated overall health and quality of life improved, compared with baseline.
CONCLUSIONS
The LIP system, which has been used for intrathecal pain management for decades, appears to offer a safe alternative for intrathecal chemotherapy in patients with leptomeningeal metastases. Further studies are warranted to clarify its potential use in this setting.
Topics: Antineoplastic Agents; Humans; Meningeal Carcinomatosis; Meningeal Neoplasms; Quality of Life; Retrospective Studies
PubMed: 34669821
DOI: 10.1590/0004-282X-ANP-2020-0554 -
Operative Neurosurgery (Hagerstown, Md.) Nov 2021Intraoperative ultrasound (iUS) is an effective guidance and imaging system commonly used in neuro-oncological surgery. Despite the versatility of iUS, its utility for...
BACKGROUND
Intraoperative ultrasound (iUS) is an effective guidance and imaging system commonly used in neuro-oncological surgery. Despite the versatility of iUS, its utility for single burr hole puncture guidance remains fairly underappreciated.
OBJECTIVE
To highlight the simplicity, versatility, and effectiveness of iUS guidance in brain puncture by presenting the current case series and technical note collection.
METHODS
We present 4 novel uses of iUS guidance for single burr hole brain puncture: cannulation of normal-sized ventricles, endoscopic third ventriculostomy (ETV) guidance, evacuation of interhemispheric empyema, and stereotactic biopsy assistance.
RESULTS
All techniques were performed successfully in a total of 16 patients. Normal-sized ventricles were cannulated in 7 patients, among whom 5 underwent Ommaya reservoir placement and 2 underwent ventriculoperitoneal shunt placement for idiopathic intracranial hypertension. No more than 1 attempt was needed for cannulation. All ventricular tip positions were optimal as shown by postoperative imaging. iUS guidance was used in 5 ETV procedures. The working cannula was successfully introduced to the lateral ventricle, providing the optimal trajectory to the third ventricular floor in these cases. Interhemispheric subdural empyema was aspirated with iUS guidance in 1 patient. Volume reduction was clearly visible, allowing near-total evacuation of the empyema. iUS guidance was used for assistive purposes during stereotactic biopsy in 3 patients. No major perioperative complications were observed throughout this series.
CONCLUSION
iUS is an effective and versatile guidance system that allows for real-time imaging and can be easily and safely employed for various brain puncture procedures.
Topics: Cerebral Ventricles; Humans; Punctures; Ultrasonography; Ventriculoperitoneal Shunt; Ventriculostomy
PubMed: 34624101
DOI: 10.1093/ons/opab330 -
Alzheimer's Research & Therapy Sep 2021Alzheimer's disease is the most common cause of dementia, and currently, there is no disease-modifying treatment. Favorable functional outcomes and reduction of amyloid...
BACKGROUNDS
Alzheimer's disease is the most common cause of dementia, and currently, there is no disease-modifying treatment. Favorable functional outcomes and reduction of amyloid levels were observed following transplantation of mesenchymal stem cells (MSCs) in animal studies.
OBJECTIVES
We conducted a phase I clinical trial in nine patients with mild-to-moderate Alzheimer's disease dementia to evaluate the safety and dose-limiting toxicity of three repeated intracerebroventricular injections of human umbilical cord blood-derived MSCs (hUCB-MSCs).
METHODS
We recruited nine mild-to-moderate Alzheimer's disease dementia patients from Samsung Medical Center, Seoul, Republic of Korea. Four weeks prior to MSC administration, the Ommaya reservoir was implanted into the right lateral ventricle of the patients. Three patients received a low dose (1.0 × 10 cells/2 mL), and six patients received a high dose (3.0 × 10 cells/2 mL) of hUCB-MSCs. Three repeated injections of MSCs were performed (4-week intervals) in all nine patients. These patients were followed up to 12 weeks after the first hUCB-MSC injection and an additional 36 months in the extended observation study.
RESULTS
After hUCB-MSC injection, the most common adverse event was fever (n = 9) followed by headache (n = 7), nausea (n = 5), and vomiting (n = 4), which all subsided within 36 h. There were three serious adverse events in two participants that were considered to have arisen from the investigational product. Fever in a low dose participant and nausea with vomiting in another low dose participant each required extended hospitalization by a day. There were no dose-limiting toxicities. Five participants completed the 36-month extended observation study, and no further serious adverse events were observed.
CONCLUSIONS
Three repeated administrations of hUCB-MSCs into the lateral ventricle via an Ommaya reservoir were feasible, relatively and sufficiently safe, and well-tolerated. Currently, we are undergoing an extended follow-up study for those who participated in a phase IIa trial where upon completion, we hope to gain a deeper understanding of the clinical efficacy of MSC AD therapy.
TRIAL REGISTRATION
ClinicalTrials.gov NCT02054208. Registered on 4 February 2014. ClinicalTrials.gov NCT03172117. Registered on 1 June 2017.
Topics: Alzheimer Disease; Animals; Fetal Blood; Follow-Up Studies; Humans; Mesenchymal Stem Cell Transplantation; Mesenchymal Stem Cells
PubMed: 34521461
DOI: 10.1186/s13195-021-00897-2 -
Neurology India 2021
Topics: Drainage; Humans; Hydrocephalus; Prostheses and Implants
PubMed: 34507465
DOI: 10.4103/0028-3886.325316 -
British Journal of Neurosurgery Oct 2021Deep lesions located in lateral and third ventricles can be accessed thorough interhemispheric transcallosal or transcortical trans-ventricular approaches. Traditional...
OBJECTIVES
Deep lesions located in lateral and third ventricles can be accessed thorough interhemispheric transcallosal or transcortical trans-ventricular approaches. Traditional brain retractors are made by 'non-cerebral engineered' spatulas, which do not equally distribute pressure on surrounding structures damaging brain. In this paper, we present a series of 20 intraventricular tumours resected through a MRI/US-navigated microscopic transcortical endoportal approach.
PATIENTS AND METHODS
Between January 2014 and December 2017, 20 patients underwent US-MRI neuronavigated (Esaote, Genova, Italy) transcortical endoportal (Vycor Viewsite Brain Access System TC Model, Vycor Medical Inc., Boca Raton, FL) surgery for intraventricular deep-seated lesions with the intent to reach maximal safe resection.
RESULTS
Gross total removal was achieved in 14 patients (70%). The only prognostic factor that resulted in statistical significance related to surgical radicality from multivariate analysis was white matter infiltration ( = 0.043), regardless of other tumour (dimensions, origin and location inside ventricular system, histopathology) and patient (age, gender, clinical presentation) characteristics. The mean duration of surgery was 225.9 min (± 59). Neither critical events, nor major bleedings, nor intraoperative deaths occurred during surgery. One case of postoperative CSF infection (5%) was registered. Six patients (30%) required permanent CSF drainage system (Ommaya reservoir, VP shunt) in the postoperative period. The mean Functional Independence Measure (FIM) score at last follow-up was 105 (range: 65-124).
CONCLUSIONS
Transcortical transventricular endoportal surgery seems to be a valuable alternative to transcallosal surgery, although further prospective multicentre studies with larger number of patients, evaluation of pre- and post-operative neuropsychological outcomes and achievement of postoperative DTI and f-MRI are needed to confirm our results.
Topics: Cerebral Ventricle Neoplasms; Cerebral Ventricles; Humans; Magnetic Resonance Imaging; Neurosurgical Procedures; Retrospective Studies; Third Ventricle
PubMed: 34348546
DOI: 10.1080/02688697.2021.1918632 -
Annals of Palliative Medicine Apr 2022Leptomeningeal metastasis (LM) is a disastrous complication in lung cancer. LM patients with oncogene-addicted non-small cell lung cancer (NSCLC) have a relatively...
Successful treatment using targeted therapy, radiotherapy, and intrathecal chemotherapy in a patient with leptomeningeal metastasis with an epidermal growth factor receptor exon 20 insertion mutation: a case report.
Leptomeningeal metastasis (LM) is a disastrous complication in lung cancer. LM patients with oncogene-addicted non-small cell lung cancer (NSCLC) have a relatively better prognosis than those with the wild-type counterpart; however, overall post-LM survival is short. Additionally, the high heterogenicity of the LM entity creates a treatment challenge, and to date, no standard strategy has been established. This article describes a female lung adenocarcinoma patient with a resistant epidermal growth factor receptor (EGFR) exon20ins mutation who developed LM only 11 months after radical surgery IIIA (pT1bN2). Intrathecal chemotherapy (ITC), whole-brain radiotherapy (WBRT) with a simultaneous integrated boost (SIB) followed by Osimertinib was initiated. The cerebrospinal fluid (CSF) cytology turned negative. The first remission lasted 6 months, then bone metastases occurred, and the LM progressed. An Ommaya reservoir was implanted. ITC with pemetrexed and anlotinib was administered. A CSF next-generation sequencing (NGS) examination revealed EGFR exon20ins (p. A767_V769 dup 1.5%), which was different from that of the primary tumor (p. V769_D770 ins ASV 17.48%). The CSF cytology then turned negative again; however, the patient succumbed to the disease in December 2020. The patient's post-LM overall survival (OS) time was 13.5 months. This case is novel and of great value. Clinicians should pay special attention to populations at high risk of developing LM. Early detection followed by active intervention, including ITC, RT, and systemic treatment, will result in a better prognosis. The NGS of CSF is fundamental to understanding the genetic profiles of LM and providing effective and precise treatment.
Topics: Carcinoma, Non-Small-Cell Lung; ErbB Receptors; Exons; Female; Humans; Lung Neoplasms; Meningeal Carcinomatosis; Mutagenesis, Insertional
PubMed: 34263612
DOI: 10.21037/apm-21-321 -
Journal of Korean Neurosurgical Society Jul 2021Here, we evaluated whether cerebrospinal fluid (CSF) profiles and their changes after intraventricular chemotherapy for leptomeningeal carcinomatosis (LMC) could predict...
OBJECTIVE
Here, we evaluated whether cerebrospinal fluid (CSF) profiles and their changes after intraventricular chemotherapy for leptomeningeal carcinomatosis (LMC) could predict the treatment response or be prognostic for patient overall survival (OS) along with clinical factors.
METHODS
Paired 1) pretreatment lumbar, 2) pretreatment ventricular, and 3) posttreatment ventricular samples and their CSF profiles were collected retrospectively from 148 LMC patients who received Ommaya reservoir installation and intraventricular chemotherapy. CSF profile changes were assessed by calculating the differences between posttreatment and pretreatment samples from the same ventricular compartment. CSF cell counts were further differentiated into total and other based on clinical laboratory reports.
RESULTS
For the treatment response, a decreased CSF 'total' cell count tended to be associated with a 'controlled' increase in intracranial pressure (ICP) (p=0.059), but other profile changes were not associated with either the control of increased ICP or the cytology response. Among the pretreatment CSF profiles, lumbar protein level and ventricular cell count were significantly correlated with OS in univariable analysis, but they were not significant in multi-variable analysis. Among CSF profile changes, a decrease in 'other' cell count showed worse OS than 'no change' or increased groups (p=0.001). The cytological response was significant for OS, but the hazard ratio of partial remission was paradoxically higher than that of 'no response'.
CONCLUSION
A decrease in other cell count of CSF after intraventricular chemotherapy was associated with poor OS in LMC patients. We suggest that more specific CSF biomarkers of cancer cell origin are needed.
PubMed: 34185980
DOI: 10.3340/jkns.2020.0300 -
American Journal of Ophthalmology Case... Jun 2021Rhino-orbital-cerebral mucormycosis (ROCM) is a rare opportunistic infection with a high mortality despite relevant treatment.
PURPOSE
Rhino-orbital-cerebral mucormycosis (ROCM) is a rare opportunistic infection with a high mortality despite relevant treatment.
OBSERVATIONS
A 3-year-old girl under treatment for acute lymphoblastic leukemia developed periorbital swelling, ophthalmoplegia and a necrotic palatal lesion during a period of neutropenia. Imaging revealed sinusitis, pre- and postseptal cellulitis. The disease later progressed to cerebral involvement and orbital apex syndrome with complete ophthalmoplegia, ptosis and loss of vision. The patient was treated with systemic antifungal therapy, hyperbaric oxygen and extensive surgery. This included orbital exenteration, skull base resection, cerebral debridement with placement of an Ommaya reservoir for intrathecal administrations of amphotericin B (AmB) and in addition endoscopic sinus surgery with local AmB installation. Chemotherapy was safely continued after resolution of the ROCM and the patient remains in complete remission after 5 years.
CONCLUSION AND IMPORTANCE
Patients with ROCM can be cured with aggressive multimodality treatment, including surgical intervention, even if in myelosuppression.
PubMed: 34095606
DOI: 10.1016/j.ajoc.2021.101092 -
Journal of Neuro-oncology May 2021Leptomeningeal carcinomatosis (LMC) is a form of CNS cancer metastasis with severe morbidity. Intrathecal chemotherapy (ITC) administration through an implanted...
PURPOSE
Leptomeningeal carcinomatosis (LMC) is a form of CNS cancer metastasis with severe morbidity. Intrathecal chemotherapy (ITC) administration through an implanted ventricular catheter reservoir (IVCR) is often utilized. Additionally, a nuclear imaging flow study can be performed prior to ITC administration to assess cerebrospinal fluid (CSF) flow. The clinical impact of a CSF flow study is unclear.
METHODS
A retrospective chart review identified 31 patients with LMC that underwent IVCR placement between 2011 and 2019. Data extracted included patient demographics, nuclear imaging flow study, surgical complications, ITC toxicities and outcomes.
RESULTS
Potential drug-induced neurologic toxicities (headache, nausea/vomiting, altered mental status, etc.) were noted in (n = 4/16) 25% of patients who underwent a flow study prior to initiation of ITC, compared to (n = 1/15) 6.6% of patients who did not undergo a flow study. Median overall survival (OS) was 4.0 and 32.8 months for the patients that underwent a flow study versus patients who did not, respectively (p < 0.01). The mean interval from IVCR implantation to initiation of ITC was 15.2 ± 8.5 days and 3.3 ± 3.0 days in patients who underwent CSF flow study and patients that did not, respectively (p < 0.0001).
CONCLUSIONS
A flow study can provide information regarding CSF flow dynamics prior to initiation of ITC; however this might delay initiation of ITC which may negatively impact OS. Additionally, in our study patients that underwent a flow study had more ITC induced drug toxicity events compared to those that did not. Further studies are needed to clarify the role of CSF flow study in these patients.
Topics: Catheters; Humans; Meningeal Carcinomatosis; Retrospective Studies
PubMed: 33860429
DOI: 10.1007/s11060-021-03756-0