小儿幕上恶性脑肿瘤中用于持续输注单纯疱疹病毒-1 G207的瘤内导管的立体定向放置
Stereotactic Placement of Intratumoral Catheters for Continuous Infusion Delivery of Herpes Simplex Virus -1 G207 in Pediatric Malignant Supratentorial Brain Tumors.
作者信息
Bernstock Joshua D, Wright Zachary, Bag Asim K, Gessler Florian, Gillespie George Yancey, Markert James M, Friedman Gregory K, Johnston James M
机构信息
Medical Scientist Training Program, University of Alabama at Birmingham, Birmingham, Alabama, USA; Department of Pediatrics, Division of Pediatric Hematology-Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Department of Neurosurgery, Division of Pediatric Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA.
出版信息
World Neurosurg. 2019 Feb;122:e1592-e1598. doi: 10.1016/j.wneu.2018.11.122. Epub 2018 Nov 24.
OBJECTIVE
The engineered herpes simplex virus-1 G207, is a promising therapeutic option for central nervous system tumors. The first-ever pediatric phase 1 trial of continuous-infusion delivery of G207 via intratumoral catheters for recurrent or progressive malignant brain tumors is ongoing. In this article, we describe surgical techniques for the accurate placement of catheters in multiple supratentorial locations and perioperative complications associated with such procedures.
METHODS
A prospective study of G207 in children with recurrent malignant supratentorial tumors is ongoing. Preoperative stereotactic protocol magnetic resonance imaging was performed, and catheter trajectories planned using StealthStation planning software. Children underwent placement of 3-4 silastic catheters using a small incision burr hole and the Vertek system. Patients had a preinfusion computed tomography scan to confirm correct placement of catheters.
RESULTS
Six children underwent implantation of 3-4 catheters. Locations of catheter placement included frontal, temporal, parietal, and occipital lobes, and the insula and thalamus. There were no clinically significant perioperative complications. Postoperative computed tomography scans coupled with preoperative MRI scans demonstrated accurate placement of 21 of 22 catheters, with 1 misplaced catheter pulled back to an optimal location at the bedside. One patient had hemorrhage along the catheter tract that was clinically asymptomatic. Another patient had cerebrospinal fluid leak from a biopsy incision 9 days after surgery that was oversewn without complication.
CONCLUSIONS
The placement of multiple intratumoral catheters in pediatric patients with supratentorial tumors via frameless stereotactic techniques is feasible and safe. Intratumoral catheters provide a potentially effective route for the delivery of G207 and may be employed in other trials utilizing oncolytic virotherapy for brain tumors.
目的
工程化单纯疱疹病毒1型G207是治疗中枢神经系统肿瘤的一种有前景的选择。有史以来首次通过瘤内导管持续输注G207治疗复发性或进展性恶性脑肿瘤的儿科1期试验正在进行。在本文中，我们描述了在幕上多个部位准确放置导管的手术技术以及与此类手术相关的围手术期并发症。
方法
一项关于G207治疗复发性幕上恶性肿瘤患儿的前瞻性研究正在进行。进行了术前立体定向方案磁共振成像，并使用StealthStation规划软件规划导管轨迹。患儿通过小切口骨孔和Vertek系统放置3 - 4根硅橡胶导管。患者在输注前进行计算机断层扫描以确认导管放置正确。
结果
6名患儿植入了3 - 4根导管。导管放置位置包括额叶、颞叶、顶叶、枕叶、岛叶和丘脑。没有具有临床意义的围手术期并发症。术后计算机断层扫描与术前磁共振成像扫描显示22根导管中有21根放置准确，1根放置错误的导管在床边被拉回到最佳位置。1例患者导管通道有出血，但临床无症状。另1例患者术后9天活检切口出现脑脊液漏，缝合后无并发症。
结论
通过无框架立体定向技术在幕上肿瘤患儿中放置多根瘤内导管是可行且安全的。瘤内导管为G207的递送提供了一条潜在有效的途径，并且可用于其他利用溶瘤病毒疗法治疗脑肿瘤的试验。
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