Nakagawa H, Fujita T, Kubo S, Izumoto S, Nakajima Y, Tsuruzono K
Dept. of Neurosurgery, Center for Adult Diseases, Osaka.
Gan To Kagaku Ryoho. 1991 Jun;18(7):1173-9.
Ventriculolumbar perfusion chemotherapy with methotrexate (MTX) and cytosine arabinoside (Ara-C) was performed in six patients with meningeal dissemination of malignant disease. Ten mg of MTX and 40 mg of Ara-C were injected via Ommaya reservoir every 12 hours for 3 days. During perfusion, we observed nausea and vomiting, low grade fever, confusion, nystagmus, paresthesia or numbness of the lower extremities, and multicranial nerve impairment, which disappeared soon after perfusion chemotherapy. After treatment, one patient developed bacterial meningitis, and two developed MTX-induced interstitial pneumonitis, which was cured by steroid therapy. Signs and symptoms due to involvement of the cerebrum, cranial nerves and spinal cord or spinal roots, improved more than by standard intrathecal chemotherapy. Laboratory cerebrospinal fluid (CSF) findings, i.e., cell count and cytological appearance, also improved more than by standard intrathecal chemotherapy. EEG, CT scan and MRI data revealed a worsening of EEG findings in one patient, and a small lesion on MRI, which was not seen by CT scan, disappeared after treatment in two patients.
对6例患有恶性疾病脑膜播散的患者进行了甲氨蝶呤（MTX）和阿糖胞苷（Ara-C）的脑室-腰椎灌注化疗。每12小时通过奥马亚贮液器注射10mg MTX和40mg Ara-C，共3天。灌注期间，我们观察到恶心、呕吐、低热、意识模糊、眼球震颤、下肢感觉异常或麻木以及多组颅神经损害，这些在灌注化疗后很快消失。治疗后，1例患者发生细菌性脑膜炎，2例发生MTX诱导的间质性肺炎，经类固醇治疗治愈。由于大脑、颅神经和脊髓或脊神经根受累引起的体征和症状，比标准鞘内化疗改善得更多。实验室脑脊液（CSF）检查结果，即细胞计数和细胞学表现，也比标准鞘内化疗改善得更多。脑电图、CT扫描和MRI数据显示，1例患者脑电图结果恶化，2例患者治疗后MRI上可见但CT扫描未发现的小病变消失。
