Use of intrathecal urokinase in repeated shunt and external ventricular drain blockage from high CSF protein due to an optic pathway glioma.
BACKGROUND
High cerebrospinal fluid (CSF) protein is a recognised association of optic pathway gliomas. This can occlude ventriculoperitoneal (VP) shunt catheters or external ventricular drains (EVD).


METHODS
We describe an 8-year-old boy with an optic pathway glioma, who had frequent episodes of a blocked VP shunt and EVD due to high CSF protein level. This responded favourably to repeated urokinase instillation into the catheter lumen. We present the course of treatment and the method of administration and review the literature behind thrombolytic therapy for occluded catheter devices.


CONCLUSIONS
Intrathecal urokinase was effective in unblocking the EVD and lysing the protein clots within the ventricle. We found no previously published cases of intrathecal urokinase for this problem. This novel intervention seemed promising as a safe and effective means of maintaining EVD patency in cases complicated by excessive protein loads in CSF and hydrocephalus.
Shooman
David
D
Department of Neurosurgery, Wessex Neurological Centre, Southampton General Hospital, Tremona Road, Southampton, Hampshire SO16 6YD, UK. Shooman@doctors.org.uk
Vajramani
Girish V
GV
Davidson
Jennifer
J
Sparrow
Owen C
OC
D001932:Brain Neoplasms / Q000134:cerebrospinal fluid / Q000150:complications / Q000601:surgery*; D002404:Catheterization; D002556:Cerebrospinal Fluid Proteins / Q000009:adverse effects*; D002648:Child; D004322:Drainage / Q000295:instrumentation; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D005910:Glioma / Q000134:cerebrospinal fluid / Q000150:complications / Q000601:surgery*; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology / Q000601:surgery; D007278:Injections, Spinal; D008297:Male; D019736:Prostheses and Implants / Q000009:adverse effects; D012086:Reoperation; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage*; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects*; D014795:Visual Pathways / Q000473:pathology
D002556:Cerebrospinal Fluid Proteins; D005343:Fibrinolytic Agents; D014568:Urokinase-Type Plasminogen Activator