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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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Occlusion of ventricular opening with collagen fleece (TachoSil®) followed by BCNU wafer (Gliadel) implantation in a case of multifocal glioblastoma. Reoperation was done for a rapidly progressive left frontal focus under chemotherapy. Twenty-four-hour MRI (a) and 10-day postoperative CCT (b) demonstrating the hypodense collagen fleece separating the resection cavity from the ventricular system in which the wafer material can be identified. c Three-month postoperative MRI T1w + GD. Ring-shaped contrast enhancement of the resection cavity was suspected as early local progression, causing mass effect. Residues of collagen fleece appear hypointense, occluding the left frontal horn of the ventricle. d Three-month postoperative T2w MRI. Spongy tissue replaces the collagen fleece (yellow arrow). Wafer remnants can be identified in the resection cavity. Despite mass effect of the cystic cavity, there are no signs of communication through the ventricular defect occluded with the collagen fleece 3 months after surgery
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Fig3: Occlusion of ventricular opening with collagen fleece (TachoSil®) followed by BCNU wafer (Gliadel) implantation in a case of multifocal glioblastoma. Reoperation was done for a rapidly progressive left frontal focus under chemotherapy. Twenty-four-hour MRI (a) and 10-day postoperative CCT (b) demonstrating the hypodense collagen fleece separating the resection cavity from the ventricular system in which the wafer material can be identified. c Three-month postoperative MRI T1w + GD. Ring-shaped contrast enhancement of the resection cavity was suspected as early local progression, causing mass effect. Residues of collagen fleece appear hypointense, occluding the left frontal horn of the ventricle. d Three-month postoperative T2w MRI. Spongy tissue replaces the collagen fleece (yellow arrow). Wafer remnants can be identified in the resection cavity. Despite mass effect of the cystic cavity, there are no signs of communication through the ventricular defect occluded with the collagen fleece 3 months after surgery

Mentions: On 3 months’ follow-up MRI, the resection cavity after BCNU wafer implantation typically showed a ring-shaped contrast enhancement around the resection cavity with varying degrees of perifocal edema [7]. This phenomenon has been well documented in the literature. Contrast enhancement will usually resolve within 3–6 months, but may persist for up to 10 months. Wafer remnants can be identified in the resection cavity on MRI for 4–6 months [9, 16]. Expectedly, this appearance of the resection cavity and dynamics of contrast enhancement were also confirmed in this study. On 3 months’ postoperative MRI, the collagen fleece appears replaced by a granulation tissue with spongy structure, hypointense on T1- and hyperintense on T2-weighted MRI (Fig. 3c, d).Fig. 3


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 ventricular opening with collagen fleece (TachoSil®) followed by BCNU wafer (Gliadel) implantation in a case of multifocal glioblastoma. Reoperation was done for a rapidly progressive left frontal focus under chemotherapy. Twenty-four-hour MRI (a) and 10-day postoperative CCT (b) demonstrating the hypodense collagen fleece separating the resection cavity from the ventricular system in which the wafer material can be identified. c Three-month postoperative MRI T1w + GD. Ring-shaped contrast enhancement of the resection cavity was suspected as early local progression, causing mass effect. Residues of collagen fleece appear hypointense, occluding the left frontal horn of the ventricle. d Three-month postoperative T2w MRI. Spongy tissue replaces the collagen fleece (yellow arrow). Wafer remnants can be identified in the resection cavity. Despite mass effect of the cystic cavity, there are no signs of communication through the ventricular defect occluded with the collagen fleece 3 months after surgery
© Copyright Policy
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC3040806&req=5

Fig3: Occlusion of ventricular opening with collagen fleece (TachoSil®) followed by BCNU wafer (Gliadel) implantation in a case of multifocal glioblastoma. Reoperation was done for a rapidly progressive left frontal focus under chemotherapy. Twenty-four-hour MRI (a) and 10-day postoperative CCT (b) demonstrating the hypodense collagen fleece separating the resection cavity from the ventricular system in which the wafer material can be identified. c Three-month postoperative MRI T1w + GD. Ring-shaped contrast enhancement of the resection cavity was suspected as early local progression, causing mass effect. Residues of collagen fleece appear hypointense, occluding the left frontal horn of the ventricle. d Three-month postoperative T2w MRI. Spongy tissue replaces the collagen fleece (yellow arrow). Wafer remnants can be identified in the resection cavity. Despite mass effect of the cystic cavity, there are no signs of communication through the ventricular defect occluded with the collagen fleece 3 months after surgery
Mentions: On 3 months’ follow-up MRI, the resection cavity after BCNU wafer implantation typically showed a ring-shaped contrast enhancement around the resection cavity with varying degrees of perifocal edema [7]. This phenomenon has been well documented in the literature. Contrast enhancement will usually resolve within 3–6 months, but may persist for up to 10 months. Wafer remnants can be identified in the resection cavity on MRI for 4–6 months [9, 16]. Expectedly, this appearance of the resection cavity and dynamics of contrast enhancement were also confirmed in this study. On 3 months’ postoperative MRI, the collagen fleece appears replaced by a granulation tissue with spongy structure, hypointense on T1- and hyperintense on T2-weighted MRI (Fig. 3c, d).Fig. 3

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