title: Complications related to the use of an intraventricular access device for the treatment of leptomeningeal metastases from solid tumor: a single centre experience in 112 patients.
abstract: Ventricular access devices (VAD) offer several advantages compared to intralumbar injections for the administration of intra-CSF agents in the treatment of leptomeningeal metastases (LM). However, there are few prospective studies reporting on complications with the use of VADs. All complications were prospectively collected that pertained to the implantation and use of a VAD in consecutive patients with solid tumor-related LM from June 2006 to December 2013. Clinical follow-up was every 2 weeks during the initial 2 months of treatment and then once monthly. Complete neuraxis MRI was performed at baseline and then every 2-3 months. A total of 112 patients (88 women) with a mean age of 51.1 years (range 26-73) were included. Primary cancers included breast (79 patients), lung (12) and melanoma (6). All patients were treated with intra-CSF liposomal cytarabine. 72 % of the patients received concomitant systemic and intra-CSF chemotherapy. The placement of the VAD was performed under local anesthesia in all cases. The mean operative time was 15 min and no perioperative complications were reported. The mean number of intraventricular injections per patient was 9.34 (range 1-47). A total of 11 complications in 11 patients were seen including 7 infections, 1 intracranial hemorrhage, 2 instances of symptomatic leukoencephalopathy and 1 catheter malpositioning. 8 complications required an operation and 1 complication was fatal. The use of a VAD is safe and may improve patients' comfort and compliance with LM-directed therapy.
authors.affiliation: Department of Neurosurgery, Hopital Roger Salengro, Lille University Hospital, Rue Emile Laine, 59037, Lille, France. fahed.zairi@gmail.com.
authors.forename: Fahed
authors.initials: F
authors.lastname: Zairi
authors.affiliation: Department of Neurosurgery, Hopital Roger Salengro, Lille University Hospital, Rue Emile Laine, 59037, Lille, France.|Department of Medical Oncology, Oscar Lambret Center, Lille, France.
authors.forename: Emilie
authors.initials: E
authors.lastname: Le Rhun
authors.affiliation: Department of Medical Oncology, Oscar Lambret Center, Lille, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Bertrand
authors.affiliation: Department of Radiology, Oscar Lambret Center, Lille, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Boulanger
authors.affiliation: Department of Neuro-Oncology Mazarin, Pitie-Salpetriere Hospital, Paris, France.|Department of Radiation Oncology, Pitie-Salpetriere Hospital, Paris, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Taillibert
authors.affiliation: Department of Neurosurgery, Hopital Roger Salengro, Lille University Hospital, Rue Emile Laine, 59037, Lille, France.
authors.forename: Rabih
authors.initials: R
authors.lastname: Aboukais
authors.affiliation: Department of Neurosurgery, Hopital Roger Salengro, Lille University Hospital, Rue Emile Laine, 59037, Lille, France.
authors.forename: Richard
authors.initials: R
authors.lastname: Assaker
authors.affiliation: Department of Neurology, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA, USA.
authors.forename: Marc C
authors.initials: MC
authors.lastname: Chamberlain
mesh_terms: D000328:Adult; D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage / Q000009:adverse effects; D001921:Brain / Q000473:pathology; D001943:Breast Neoplasms / Q000473:pathology; D002408:Catheters, Indwelling / Q000009:adverse effects*; D003561:Cytarabine / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007276:Injections, Intraventricular / Q000009:adverse effects* / Q000295:instrumentation*; D008175:Lung Neoplasms / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008545:Melanoma / Q000473:pathology; D008577:Meningeal Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D008875:Middle Aged; D011446:Prospective Studies; D013116:Spinal Cord / Q000473:pathology
chemical_list: D000964:Antimetabolites, Antineoplastic; D003561:Cytarabine
keywords: Complications; Infection intraventricular intra-CSF treatment; Leptomeningeal meningitis; Ventricular access device