Robot-guided convection-enhanced delivery of carboplatin for advanced brainstem glioma
Robot-guided convection-enhanced delivery of carboplatin for advanced brainstem glioma
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DOI：
10.1007/s00701-013-1700-6
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发表时间：
2013-08-01
影响因子：
2.4
通讯作者：
Gill, S. S.
中科院分区：
文献类型：
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作者：
Barua, N. U.;Lowis, S. P.;Gill, S. S.
弥漫性脑桥内胶质瘤（DIPG）患者的预后较差，据报道中位生存期为9个月。全身化疗未能改善预后可能是由于血脑屏障（BBB）渗透不足。对流增强分娩（CED）有可能通过促进绕过BBB来改善结局。我们描述了首次使用机器人引导导管植入技术使用卡铂治疗晚期DIPG。尽管进行了放疗，肿瘤仍继续进展。使用对神经启发立体定向规划软件（Renishaw Plc.，英国格洛斯特郡），肿瘤体积计算为43.6 ml。计划了导管植入的经额轨迹，以便于内部制造凹阶导管。使用神经伴侣机器人（Renishaw Plc.，Gloucestershire，UK）。卡铂（0.09 mg/ml）的初始输注开始于实时T2加权MRI，便于估计输注液分布的体积。重复输注共5天，导管植入和输注耐受性良好。在5天内输送了49.8 ml的总体积。最终输注完成时的T2加权MRI显示，总体积为35.1 ml的信号变化，占靶肿瘤体积的95%。4周随访显示临床体征改善，整个分布容积的T2信号变化增加。然而，有肿瘤的分布容积以外的地区的进展。这个案例证明了准确和安全地提供小直径导管的脑干使用机器人引导植入程序的可行性，和实时MRI跟踪输液分布。
Patients with diffuse intrinsic pontine glioma (DIPG) have a poor prognosis with median survival reported as 9 months. The failure of systemic chemotherapy to improve prognosis may be due to inadequate penetration of the blood-brain barrier (BBB). Convection-enhanced delivery (CED) has the potential to improve outcomes by facilitating bypass of the BBB. We describe the first use of carboplatin for the treatment of advanced DIPG using a robot-guided catheter implantation technique.A 5-year-old boy presented with a pontine mass lesion. The tumor continued to progress despite radiotherapy. Using an in-house modification to neuroinspire stereotactic planning software (Renishaw Plc., Gloucestershire, UK), the tumor volume was calculated as 43.6 ml. A transfrontal trajectory for catheter implantation was planned facilitating the in-house manufacture of a recessed-step catheter. The catheter was implanted using a neuromate robot (Renishaw Plc., Gloucestershire, UK). The initial infusion of carboplatin (0.09 mg/ml) was commenced with real-time T2-weighted MRI, facilitating estimation of the volume of infusate distribution. Infusions were repeated on a total of 5 days.The catheter implantation and infusions were well tolerated. A total volume of 49.8 ml was delivered over 5 days. T2-weighted MRI on completion of the final infusion demonstrated signal change through a total volume of 35.1 ml, representing 95 % of the targeted tumor volume. Follow-up at 4 weeks revealed clinical signs of improvement and increased T2 signal change throughout the volume of distribution. However, there was tumor progression in the regions outside the volume of distribution.This case demonstrates the feasibility of accurately and safely delivering small-diameter catheters to the brainstem using a robot-guided implantation procedure, and real-time MRI tracking of infusate distribution.