A New Tool for the Navigated Placement of Intracerebral Chemotherapy Catheters

Abstract

Objective: The aim of this report is to illustrate a method for the precise placement of chemotherapeutic delivery catheters with the aid of computer-assisted navigation systems.

Materials and Methods: We have developed a cannula which can be referenced to our navigation system (BrainLab^®) to advance and position catheters. The cannula has a length of 10 cm. In the case of a ventricular puncture, CSF will drain through holes at the tip and a side port of the cannula to caution the surgeon. The cannula is fixed to the BrainLab^® adapter ML and navigated with a BrainLab^® vector vision^® system. Using the puncture software, the placement is planned and executed. After placing the cannula as planned, the mandrin is removed and the primed catheter moved forward. When resistance is felt the cannula is withdrawn over the catheter. Further catheters can be placed similarly.

Results: Initial phantom tests showed a good target accuracy. Clinically we have used the cannula in 7 cases with good accuracy.

Conclusion: This newly designed tool is easy to handle and well integrated into the navigation system. It provides the means to place catheters precisely to the planned position. Potentially it can be combined with every navigation system using adaptable reference systems.

Key words

intracranial tumor - key-hole approach - intrathecal chemotherapy - neurooncology - minimally invasive neurosurgery

References

• 1 Bobo RH, Laske DW, Akybasak A. et al . Convection-enhanced delivery of macromolecules in the brain.  Proc Natl Acad Sci USA. 1994;  91 2076-2080
• 2 Boulikas RH, Lundstrom K, Soling A. et al . Immunogene therapy of recurrent glioblastoma multiforme with a liposomally encapsulated replication-incompetent Semlinki forest virus vector carrying the human interleukin-12 gene: a phase I/II clinical protocoll.  J Neurooncol. 2003;  64 147-152
• 3 Husain SR, Pruri RK. Interleukin-13 receptor-directed cytotoxin for malignant glioblastoma therapy: from bench to bedside.  J Neurooncol. 2003;  65 37-48
• 4 Kunar S. Convection enhanced delivery of IL13-PE38QQR for treatment of recurrent malignant glioma: presentation of interim findings from ongoing phase 1 studies.  Acta Neurochir Suppl. 2003;  88 105-111
• 5 Lidar Z, Mardor Y, Jonas T. et al . Convection-enhanced delivery of paclitaxel for the treatment of recurrent malignant glioma: a phase I/II clinical study.  J Neurosurg. 2003;  100 472-479
• 6 Weaver M, Laske DW. Transferrin receptor ligand-targeted toxin conjugate (Tf-CRM107) for therapy of malignant gliomas.  J Neurooncol. 2003;  65 3-13
• 7 Weber FW, Floth F, Asher A. et al . Local convection enhanced delivery of IL4-Pseudomonas exo (NB!-3001) for treatment of patients with recurrent malignant glioma.  Acta Neurochir Suppl. 2003;  88 93-103
• 8 Price R. The advantages of frameless stereotactic biopsy over frame-based biopsy.  Br J Neurosurg. 2003;  17 90-91
• 9 Ungersbock K, Aichholz M, Gunthner M. et al . Cavernous malformations: from frame-based to frame less stereotactic localization.  Minim Invas Neurosurg. 1997;  40 134-138
• 10 Li QH, Zamorano L, Pandya A. et al . The application accuracy of the Neuromat robot – A quantitative comparison with frameless and frame-based surgical localization systems.  Comput Aided Surg. 2002;  7 90-98

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