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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.

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Appearance of collagen fleece (TachoSil®) and BCNU wafers (Gliadel) on postoperative imaging in a case of recurrent malignant glioma. a Four-hour postoperative CCT: The collagen fleece is occluding the entire ventricular defect; BCNU wafers are detectable within the resection cavity. b Postoperative (24-h) MRI T2w: Hypointense collagen fleece separates the tumor cavity from the ventricle. c T1w + GD, there is no enhancement of the wafer structure or the adjacent brain and the collagen fleece appears hypointense; otherwise, there were no signs of enhancement of the ependyma
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Fig2: Appearance of collagen fleece (TachoSil®) and BCNU wafers (Gliadel) on postoperative imaging in a case of recurrent malignant glioma. a Four-hour postoperative CCT: The collagen fleece is occluding the entire ventricular defect; BCNU wafers are detectable within the resection cavity. b Postoperative (24-h) MRI T2w: Hypointense collagen fleece separates the tumor cavity from the ventricle. c T1w + GD, there is no enhancement of the wafer structure or the adjacent brain and the collagen fleece appears hypointense; otherwise, there were no signs of enhancement of the ependyma

Mentions: Four-hour postoperative CT scans in all patients showed residual air and the BCNU wafers appearing as hyperdense linear structures within the resection cavity. The collagen fleece could be identified as a linear structure hypodense to white matter separating the resection cavity from the ventricular lumen (Fig. 2a). On a 24-h postoperative MRI (Fig. 2b, c), as previously described, the BCNU wafers in all patients appeared as hypointense structures; after administration of gadolinium contrast material, no enhancement of the wafer structure or adjacent brain was observed [8, 9, 16]. The collagen fleece appeared hypointense on T1-weighted MRI between the ventricular lumen and the resection cavity. In all cases, tri-planar MRI demonstrated a separation of the resection cavity from the ventricular system by the collagen fleece. In no case did early CCT or MRI reveal wafer material within the ventricular system or signs of obstructive hydrocephalus (Table 2). In no case was contrast enhancement of the ependyma as a sign of aseptic ventriculitis observed [8].Fig. 2


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)

Appearance of collagen fleece (TachoSil®) and BCNU wafers (Gliadel) on postoperative imaging in a case of recurrent malignant glioma. a Four-hour postoperative CCT: The collagen fleece is occluding the entire ventricular defect; BCNU wafers are detectable within the resection cavity. b Postoperative (24-h) MRI T2w: Hypointense collagen fleece separates the tumor cavity from the ventricle. c T1w + GD, there is no enhancement of the wafer structure or the adjacent brain and the collagen fleece appears hypointense; otherwise, there were no signs of enhancement of the ependyma
© Copyright Policy
Related In: Results  -  Collection

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

Fig2: Appearance of collagen fleece (TachoSil®) and BCNU wafers (Gliadel) on postoperative imaging in a case of recurrent malignant glioma. a Four-hour postoperative CCT: The collagen fleece is occluding the entire ventricular defect; BCNU wafers are detectable within the resection cavity. b Postoperative (24-h) MRI T2w: Hypointense collagen fleece separates the tumor cavity from the ventricle. c T1w + GD, there is no enhancement of the wafer structure or the adjacent brain and the collagen fleece appears hypointense; otherwise, there were no signs of enhancement of the ependyma
Mentions: Four-hour postoperative CT scans in all patients showed residual air and the BCNU wafers appearing as hyperdense linear structures within the resection cavity. The collagen fleece could be identified as a linear structure hypodense to white matter separating the resection cavity from the ventricular lumen (Fig. 2a). On a 24-h postoperative MRI (Fig. 2b, c), as previously described, the BCNU wafers in all patients appeared as hypointense structures; after administration of gadolinium contrast material, no enhancement of the wafer structure or adjacent brain was observed [8, 9, 16]. The collagen fleece appeared hypointense on T1-weighted MRI between the ventricular lumen and the resection cavity. In all cases, tri-planar MRI demonstrated a separation of the resection cavity from the ventricular system by the collagen fleece. In no case did early CCT or MRI reveal wafer material within the ventricular system or signs of obstructive hydrocephalus (Table 2). In no case was contrast enhancement of the ependyma as a sign of aseptic ventriculitis observed [8].Fig. 2

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