Limits...
Occlusion of surgical opening of the ventricular system with fibrinogen-coated collagen fleece: a case collection study.

Bock HC, Cohnen J, Keric N, Kantelhardt SR, Giese A - Acta Neurochir (Wien) (2011)

Bottom Line: In no case did early CCT/MRI or follow-up MRI reveal wafer material within the ventricular system.In no case did signs of obstructive hydrocephalus occur.No morphological evidence for wafer material dislocation into the ventricular system or obstruction of CSF pathways was found in nine patients who received 41 follow-up MRI over 10.4 months of follow-up.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Center of Neurological Medicine, University of Göttingen, Robert-Koch-Strasse 40, 37075, Göttingen, Germany. cbock@gmx.de

ABSTRACT

Background: Implantation of 1,3-bis (2-chloroethyl)-1-nitrosourea (BCNU) wafer for malignant glioma is not recommended in the case of surgical opening of the ventricular system during microsurgical tumor resection because the wafer material may dislocate from the resection cavity into the ventricular system and cause obstructive hydrocephalus. TachoSil is an adhesive collagen fleece used in different surgical disciplines that provides an air- and liquid-tight seal closing communications between the ventricular system and the resection cavity after tumor removal.

Methods: Occlusion of ventricular defects with TachoSil after microsurgical glioma resection was performed in two patients with newly diagnosed and seven patients with recurrent malignant glioma prior to BCNU wafer implantation into the resection cavity. Early postoperative cranial computed tomography (CCT)/MRI and follow-up MRI at 3 months' intervals were performed with a median follow-up of 10.4 months.

Results: The collagen fleece was identified as a linear structure hypodense/hypointense to white matter on postoperative CT/MRI separating the resection cavity from the ventricular lumen in all cases. In no case did early CCT/MRI or follow-up MRI reveal wafer material within the ventricular system. In no case did signs of obstructive hydrocephalus occur.

Conclusion: Sealing of the ventricular system using a fibrinogen-coated collagen fleece effectively separates the resection cavity from the ventricular system and allows implantation of BCNU wafers into the resection cavity. No morphological evidence for wafer material dislocation into the ventricular system or obstruction of CSF pathways was found in nine patients who received 41 follow-up MRI over 10.4 months of follow-up.

Show MeSH

Related in: MedlinePlus

Occlusion of surgical opening of the ventricular system after resection of a recurrent malignant glioma (patient 7) using a fibrinogen-coated collagen fleece (TachoSil®) prior to implantation of BCNU wafers (Gliadel). a Opening of the right frontal horn of the ventricle. b Occlusion of the ventricular fenestration by TachoSil®. c Implantation of seven BCNU-containing wafers (Gliadel)
© Copyright Policy
Related In: Results  -  Collection


getmorefigures.php?uid=PMC3040806&req=5

Fig1: Occlusion of surgical opening of the ventricular system after resection of a recurrent malignant glioma (patient 7) using a fibrinogen-coated collagen fleece (TachoSil®) prior to implantation of BCNU wafers (Gliadel). a Opening of the right frontal horn of the ventricle. b Occlusion of the ventricular fenestration by TachoSil®. c Implantation of seven BCNU-containing wafers (Gliadel)

Mentions: From August 2005 to July 2010, 19 patients with newly diagnosed malignant gliomas and 24 patients treated for recurrent malignant gliomas at our institution were treated by microsurgical tumor resection followed by implantation of BCNU wafers. In nine patients (21%), the location of tumors required wide opening of the ventricles to allow gross total resection of tumors, resulting in fenestrations of the ventricular system larger than 10 mm. The diameter of BCNU wafers measures 14 mm. Because eroding wafers decrease in size and the geometry of resection cavities frequently requires implantation of wafer fragments, openings of the ventricular system larger than 10 mm were not considered safe for wafer implantation. All patients gave written consent to the surgical procedure, including tumor resection with opening of the ventricular system followed by occlusion using a collagen fleece and local BCNU wafer implantation. In one patient with newly diagnosed and eight patients with recurrent malignant gliomas, surgical openings of the ventricular system were closed using TachoSil® (Table 1). The collagen fleece was cut to cover the entire defect and overlap with the adjacent resection edge by at least 5 mm. The fleece was applied wet and pressed to the tissue surface using dry surgical cotton for 1 min; then, the cotton was removed and the resection cavity was kept dry for 5 min. The resection cavity was rinsed to ensure hemostasis and the BCNU wafers implanted (Fig. 1). The dura and wound were closed and perioperative antibiotics and dexamethasone schedule was given adhering to a protocol specifically designed to avoid wound healing abnormalities and to minimize other risks associated with local chemotherapy using BCNU wafers [7].Table 1


Occlusion of surgical opening of the ventricular system with fibrinogen-coated collagen fleece: a case collection study.

Bock HC, Cohnen J, Keric N, Kantelhardt SR, Giese A - Acta Neurochir (Wien) (2011)

Occlusion of surgical opening of the ventricular system after resection of a recurrent malignant glioma (patient 7) using a fibrinogen-coated collagen fleece (TachoSil®) prior to implantation of BCNU wafers (Gliadel). a Opening of the right frontal horn of the ventricle. b Occlusion of the ventricular fenestration by TachoSil®. c Implantation of seven BCNU-containing wafers (Gliadel)
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3040806&req=5

Fig1: Occlusion of surgical opening of the ventricular system after resection of a recurrent malignant glioma (patient 7) using a fibrinogen-coated collagen fleece (TachoSil®) prior to implantation of BCNU wafers (Gliadel). a Opening of the right frontal horn of the ventricle. b Occlusion of the ventricular fenestration by TachoSil®. c Implantation of seven BCNU-containing wafers (Gliadel)
Mentions: From August 2005 to July 2010, 19 patients with newly diagnosed malignant gliomas and 24 patients treated for recurrent malignant gliomas at our institution were treated by microsurgical tumor resection followed by implantation of BCNU wafers. In nine patients (21%), the location of tumors required wide opening of the ventricles to allow gross total resection of tumors, resulting in fenestrations of the ventricular system larger than 10 mm. The diameter of BCNU wafers measures 14 mm. Because eroding wafers decrease in size and the geometry of resection cavities frequently requires implantation of wafer fragments, openings of the ventricular system larger than 10 mm were not considered safe for wafer implantation. All patients gave written consent to the surgical procedure, including tumor resection with opening of the ventricular system followed by occlusion using a collagen fleece and local BCNU wafer implantation. In one patient with newly diagnosed and eight patients with recurrent malignant gliomas, surgical openings of the ventricular system were closed using TachoSil® (Table 1). The collagen fleece was cut to cover the entire defect and overlap with the adjacent resection edge by at least 5 mm. The fleece was applied wet and pressed to the tissue surface using dry surgical cotton for 1 min; then, the cotton was removed and the resection cavity was kept dry for 5 min. The resection cavity was rinsed to ensure hemostasis and the BCNU wafers implanted (Fig. 1). The dura and wound were closed and perioperative antibiotics and dexamethasone schedule was given adhering to a protocol specifically designed to avoid wound healing abnormalities and to minimize other risks associated with local chemotherapy using BCNU wafers [7].Table 1

Bottom Line: In no case did early CCT/MRI or follow-up MRI reveal wafer material within the ventricular system.In no case did signs of obstructive hydrocephalus occur.No morphological evidence for wafer material dislocation into the ventricular system or obstruction of CSF pathways was found in nine patients who received 41 follow-up MRI over 10.4 months of follow-up.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Center of Neurological Medicine, University of Göttingen, Robert-Koch-Strasse 40, 37075, Göttingen, Germany. cbock@gmx.de

ABSTRACT

Background: Implantation of 1,3-bis (2-chloroethyl)-1-nitrosourea (BCNU) wafer for malignant glioma is not recommended in the case of surgical opening of the ventricular system during microsurgical tumor resection because the wafer material may dislocate from the resection cavity into the ventricular system and cause obstructive hydrocephalus. TachoSil is an adhesive collagen fleece used in different surgical disciplines that provides an air- and liquid-tight seal closing communications between the ventricular system and the resection cavity after tumor removal.

Methods: Occlusion of ventricular defects with TachoSil after microsurgical glioma resection was performed in two patients with newly diagnosed and seven patients with recurrent malignant glioma prior to BCNU wafer implantation into the resection cavity. Early postoperative cranial computed tomography (CCT)/MRI and follow-up MRI at 3 months' intervals were performed with a median follow-up of 10.4 months.

Results: The collagen fleece was identified as a linear structure hypodense/hypointense to white matter on postoperative CT/MRI separating the resection cavity from the ventricular lumen in all cases. In no case did early CCT/MRI or follow-up MRI reveal wafer material within the ventricular system. In no case did signs of obstructive hydrocephalus occur.

Conclusion: Sealing of the ventricular system using a fibrinogen-coated collagen fleece effectively separates the resection cavity from the ventricular system and allows implantation of BCNU wafers into the resection cavity. No morphological evidence for wafer material dislocation into the ventricular system or obstruction of CSF pathways was found in nine patients who received 41 follow-up MRI over 10.4 months of follow-up.

Show MeSH
Related in: MedlinePlus