Use of a stop-flow programmable shunt valve to maximize CNS chemotherapy delivery in a pediatric patient with acute lymphoblastic leukemia

Sheri K. Palejwala, David A. Stidd, Jesse M. Skoch, Puja Gupta, Gerald M Lemole, Martin E Weinand

Research output: Contribution to journalArticle

Abstract

Background: The requirement for frequent intraventricular drug delivery in the setting of shunt dependence is particularly challenging in the treatment of central nervous system infection, neoplastic disease, and hemorrhage. This is especially relevant in the pediatric population where both hematogenous malignancy requiring intrathecal drug delivery and shunt-dependent hydrocephalus are more prevalent. Intrathecal and intraventricular chemotherapy agents can be prematurely diverted in these shunt-dependent patients. Case Description: We report the use of a stop-flow programmable shunt valve to maximize delivery of intraventricular chemotherapy in a child with acute lymphoblastic leukemia and disseminated intravascular coagulation who presented with spontaneous intracerebral and intraventricular hemorrhages. The patient then developed posthemorrhagic hydrocephalus and eventually progressed to shunt dependence but still required frequent intraventricular chemotherapy administration. A ventriculoperitoneal shunt, equipped with a valve that allows for near cessation of cerebrospinal fluid flow (Certas, Codman, Raynham, MA), and a contralateral Ommaya reservoir were inserted to maximize intraventricular dissemination of chemotherapy. Conclusions: To the best of our knowledge, this is the first reported case of the use of a high-resistance programmable valve being used to virtually cease cerebrospinal fluid flow through the distal catheter temporarily in order to maximize intraventricular drug dissemination in a pediatric patient with acute lymphoblastic leukemia. Copyright:

Original languageEnglish (US)
JournalSurgical Neurology International
Volume5
Issue numberSUPPL. 4
DOIs
StatePublished - 2014

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Precursor Cell Lymphoblastic Leukemia-Lymphoma
Pediatrics
Drug Therapy
Hydrocephalus
Cerebrospinal Fluid
Pharmaceutical Preparations
Ventriculoperitoneal Shunt
Central Nervous System Infections
Disseminated Intravascular Coagulation
Cerebral Hemorrhage
Catheters
Hemorrhage
Population
Neoplasms
Therapeutics

Keywords

  • Chemotherapy
  • hydrocephalus
  • intracerebral hemorrhage
  • pediatric neurosurgery
  • ventriculoperitoneal shunt

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Use of a stop-flow programmable shunt valve to maximize CNS chemotherapy delivery in a pediatric patient with acute lymphoblastic leukemia. / Palejwala, Sheri K.; Stidd, David A.; Skoch, Jesse M.; Gupta, Puja; Lemole, Gerald M; Weinand, Martin E.

In: Surgical Neurology International, Vol. 5, No. SUPPL. 4, 2014.

Research output: Contribution to journalArticle

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