Department of Neurosurgery, Padua University Hospital, Padova, Italy.
World Neurosurg. 2011 Jul-Aug;76(1-2):156-9; discussion 67-8. doi: 10.1016/j.wneu.2010.10.024.
Implantation of carmustine (1,3-bis (2 chloroetyl)-1-nitrosurea [BCNU]) wafers is an approved local treatment after surgical removal of high-grade gliomas. Safety data have been largely reported by phase III studies. The communication between the final surgical cavity and the ventricular cavities is supposed to be a relative contraindication for positioning of the wafers because of the possible development of hydrocephalus. However, at present there are neither data about this topic published with the exception of a few case reports, nor any proposals for selection criteria for wafer implantation in such circumstances. Furthermore, there are no technical suggestions in literature put forward for the surgical repairing of ventricular defects. Our study was particularly focused on addressing these 3 issues.
Forty-three patients affected by a high-grade glioma underwent surgical removal and BCNU wafer implantation between March 2007 and September 2009 at the Department of Neurosurgery of Padua. Among them, we retrospectively reviewed clinical, surgical, and radiological data of 9 patients who had been treated with carmustine wafers after surgical repair of communication between the surgical cavity and the ventricular cavities. We also focused on the technical details concerning wafers positioning in this particular situation.
Ventricular defects were present in the atrium in 4, frontal horn in 3, and temporal horn in 2 cases. The maximum diameter of the defect was between 6 and 10 mm. In all cases, the defect was intraoperatively repaired in the same way, and up to 8 wafers were implanted in the surgical cavity. In the series reported, no cases of hydrocephalus were detected.
In our experience, integrity of wafers, size of ventricular wall defect, and accuracy in repairing the defect were crucial issues. Nevertheless, more experience and prospective studies would be helpful to clarify both in what measure ventricular opening affects safety data and the best reliable way of repairing ventricular defects when BCNU wafers are implanted.
卡莫司汀（1,3-双（2-氯乙基）-1-亚硝基脲[BCNU]）植入物是高级别神经胶质瘤切除术后批准的局部治疗方法。安全性数据主要通过 III 期研究报告。由于可能发生脑积水，最终手术腔与脑室腔之间的沟通被认为是放置晶片的相对禁忌症。然而，目前除了少数病例报告外，没有关于这个主题的公开数据，也没有针对这种情况下晶片植入的选择标准的建议。此外，文献中没有提出用于修复脑室缺陷的技术建议。我们的研究特别关注解决这 3 个问题。
2007 年 3 月至 2009 年 9 月，帕多瓦神经外科的 43 名高级别神经胶质瘤患者接受了手术切除和 BCNU 晶片植入。其中，我们回顾性分析了 9 名在手术腔与脑室腔之间沟通修复后接受卡莫司汀晶片治疗的患者的临床、手术和影像学资料。我们还重点关注了在这种特殊情况下晶片定位的技术细节。
4 例存在于心房，3 例存在于额角，2 例存在于颞角。缺陷的最大直径在 6 到 10 毫米之间。在所有病例中，缺陷均在术中以相同方式修复，在手术腔中植入了多达 8 个晶片。在报告的系列中，未发现脑积水病例。
根据我们的经验，晶片的完整性、心室壁缺陷的大小以及修复缺陷的准确性是至关重要的问题。然而，更多的经验和前瞻性研究将有助于澄清脑室开口在多大程度上影响安全性数据，以及在植入 BCNU 晶片时修复脑室缺陷的最佳可靠方法。
