Sudhakar Vivek, Naidoo Jerusha, Samaranch Lluis, Bringas John R, Lonser Russell R, Fiandaca Massimo S, Bankiewicz Krystof S
1Department of Neurological Surgery, University of California, San Francisco, California; and.
2Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.
J Neurosurg. 2019 Jul 12;133(2):530-537. doi: 10.3171/2019.4.JNS19826. Print 2020 Aug 1.
To develop and assess a convective delivery technique that enhances the effectiveness of drug delivery to nonspherical brain nuclei, the authors developed an occipital "infuse-as-you-go" approach to the putamen and compared it to the currently used transfrontal approach.
Eleven nonhuman primates received a bilateral putamen injection of adeno-associated virus with 2 mM gadolinium-DTPA by real-time MR-guided convective perfusion via either a transfrontal (n = 5) or occipital infuse-as-you-go (n = 6) approach.
MRI provided contemporaneous assessment and monitoring of putaminal infusions for transfrontal (2 to 3 infusion deposits) and occipital infuse-as-you-go (stepwise infusions) putaminal approaches. The infuse-as-you-go technique was more efficient than the transfrontal approach (mean 35 ± 1.1 vs 88 ± 8.3 minutes [SEM; p < 0.001]). More effective perfusion of the postcommissural and total putamen was achieved with the infuse-as-you-go versus transfronatal approaches (100-µl infusion volumes; mean posterior commissural coverage 76.2% ± 5.0% vs 32.8% ± 2.9% [p < 0.001]; and mean total coverage 53.5% ± 3.0% vs 38.9% ± 2.3% [p < 0.01]).
The infuse-as-you-go approach, paralleling the longitudinal axis of the target structure, provides a more effective and efficient method for convective infusate coverage of elongated, irregularly shaped subcortical brain nuclei.
为开发并评估一种能提高药物向非球形脑核团递送效果的对流递送技术，作者研发了一种枕部“边走边注入”法用于壳核，并将其与目前使用的经额部方法进行比较。
11只非人灵长类动物通过实时磁共振引导的对流灌注，经额部（n = 5）或枕部边走边注入（n = 6）方法，接受双侧壳核注射含2 mM钆-二乙三胺五乙酸的腺相关病毒。
磁共振成像对经额部（2至3个注入点）和枕部边走边注入（逐步注入）壳核方法的壳核注入进行了同步评估和监测。边走边注入技术比经额部方法更高效（平均35 ± 1.1分钟对88 ± 8.3分钟[标准误；p < 0.001]）。与经额部方法相比，边走边注入方法在后连合部及整个壳核实现了更有效的灌注（注入体积100 μl；平均后连合部覆盖率76.2% ± 5.0%对32.8% ± 2.9%[p < 0.001]；平均总覆盖率53.5% ± 3.0%对38.9% ± （此处原文有误，应为2.3%）[p < 0.01]）。
边走边注入方法与目标结构的纵轴平行，为对流注入物覆盖细长、不规则形状的皮质下脑核团提供了一种更有效且高效的方法。
