Kawaguchi Yuki, Hanakita Shunya, Yoshida Shinsuke, Ikemoto Tomoko, Oya Soichi
Neurosurgery, Saitama Medical Center, Saitama Medical University, Kawagoe, JPN.
Cureus. 2024 May 6;16(5):e59718. doi: 10.7759/cureus.59718. eCollection 2024 May.
Gliadel wafer implants (Eisai Inc., Woodcliff Lake, NJ, USA) have shown their efficacy in prolonging survival in patients with malignant gliomas. The safety of Gliadel wafers has also been reported; however, there is a certain risk of adverse events. We present a rare case of refractory cerebrospinal fluid (CSF) leakage with eosinophilic meningitis in a patient with glioblastoma who underwent tumor resection with Gliadel wafer implants. A 60-year-old man presented with a glioblastoma in the right temporal lobe. The patient underwent tumor resection with Gliadel wafer implants. During the postoperative course, the patient presented with intractable CSF leakage and the development of a pseudomeningocele. A delayed rise in blood and CSF eosinophil count (a few weeks after the primary operation) and positive drug-induced lymphocyte stimulation test (DLST) results against the Gliadel wafer led to the diagnosis of an allergic reaction to these implants. Removal of the Gliadel wafers resolved the eosinophilic reaction; however, the patient subsequently required a shunt procedure for persistent hydrocephalus. This case highlights the importance of investigating rare causes of refractory CSF leakage and hydrocephalus due to allergic reactions to Gliadel wafers. Delayed elevations of eosinophils in blood and CSF tests may lead to a diagnosis of eosinophilic meningitis. DLST against Gliadel wafers is also useful for diagnosis when it is available. To control the hydrocephalus, not only the shunt procedure but also wafer removal must be considered; however, patients with limited life expectancy are generally hesitant to undergo such additional procedures.
Gliadel 薄片植入物（美国新泽西州伍德克利夫湖市卫材株式会社）已显示出其在延长恶性胶质瘤患者生存期方面的疗效。Gliadel 薄片的安全性也已有报道；然而，存在一定的不良事件风险。我们报告了一例罕见的胶质母细胞瘤患者，在接受 Gliadel 薄片植入物肿瘤切除术后发生难治性脑脊液（CSF）漏合并嗜酸性粒细胞性脑膜炎的病例。一名 60 岁男性患者，右侧颞叶患有胶质母细胞瘤。该患者接受了 Gliadel 薄片植入物肿瘤切除术。术后过程中，患者出现难治性脑脊液漏并形成假性脑膜膨出。血液和脑脊液嗜酸性粒细胞计数延迟升高（初次手术后数周）以及针对 Gliadel 薄片的药物诱导淋巴细胞刺激试验（DLST）结果呈阳性，导致诊断为对这些植入物的过敏反应。取出 Gliadel 薄片后，嗜酸性反应得到缓解；然而，患者随后因持续性脑积水需要进行分流手术。该病例强调了调查因对 Gliadel 薄片过敏反应导致难治性脑脊液漏和脑积水的罕见原因的重要性。血液和脑脊液检查中嗜酸性粒细胞的延迟升高可能导致嗜酸性粒细胞性脑膜炎的诊断。当有条件时，针对 Gliadel 薄片的 DLST 对诊断也很有用。为控制脑积水，不仅要考虑分流手术，还必须考虑取出薄片；然而，预期寿命有限的患者通常对接受此类额外手术犹豫不决。
