Advanced

AJNR - American Journal of Neuroradiology

This Article Abstract Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Fortin, D. Articles by Benko, A. Search for Related Content PubMed PubMed Citation Articles by Fortin, D. Articles by Benko, A.

Technical Modification in the Intracarotid Chemotherapy and Osmotic Blood-Brain Barrier Disruption Procedure to Prevent the Relapse of Carboplatin-Induced Orbital Pseudotumor

David Fortin^a, Joseph A. Salamé^a, Annick Desjardins^a,b and Andrew Benko^a,b

^a Department of Neurosurgery and Neurooncology, CHUS, Sherbrooke, Quebec, Canada
^b Department of Radiology, CHUS, Sherbrooke, Quebec, Canada

View larger version (110K): [in a new window]   FIG 1. Photograph of patient 1, taken 12 hours after he presented with the first stigmata of the pseudotumor syndrome. Note the exophthalmia, hyperemia, and chemosis of the right eye.

View larger version (87K): [in a new window]   FIG 2. Axial (A) and coronal (B) CT images, demonstrating the right-sided exophthalmia, fat infiltration, and swelling of intraorbital muscles and lacrimal gland in patient 1. CT was performed 14 hours after the initiation of the pseudotumor syndrome.

View larger version (75K): [in a new window]   FIG 3. MR characteristics of the pseudotumor syndrome as displayed in patient 2. A, Axial T1-weighted brain MR imaging highlighting the left-sided exophthalmia and swelling of the extraocular muscles. B, Contrast-enhanced T1-weighted MR study in the same patient depicting enhancement of the extraocular muscles of the left orbital cavity.

View larger version (86K): [in a new window]   FIG 4. Response obtained in the treatment of a 67-year-old patient with a primary CNS lymphoma (patient 2). Before study accrual, the patient had been treated with high-dose intravenous methotrexate and radiation and had not responded to these modalities. A, Axial T1-weighted brain MR image obtained at study accrual in April 2001. The highly and homogeneously left frontal enhancing lesion is obvious, as well as the surrounding vasogenic edema. A mass effect is produced on the ipsilateral ventricle, as well as on the gyri. B, Axial T1-weighted brain MR image obtained before the 10th cycle, in April 2002. The tumoral nodule has completely receded, and presence of left frontal encephalomalacia and a vacuum effect on the left frontal horn translate the decrease in mass effect.

View larger version (58K): [in a new window]   FIG 5. The modified BBBD technique applied in patient 2. The patient had just undergone mannitol infusion. A, The catheter has been changed for a 3.5 microcatheter tracker and a first infusion is accomplished. B, The catheter is moved caudally until the identification of the origin of the ophthalmic artery. C, The catheter is positioned just above the origin of the ophthalmic artery to bypass it. Chemotherapy is infused in a supraophthalmic setting after the BBB has been disrupted by using the standard infraophthalmic carotid mannitol infusion.