Intraventricular urokinase to treat a blocked ventriculoperitoneal shunt in a glioblastoma patient with leptomeningeal spread

Leptomeningeal spread and hydrocephalus are increasingly recognized as late disease complications of glioblastoma with almost a quarter of patients requiring early cerebrospinal fluid shunting. The neurosurgeon is challenged with maintaining shunt patency when tumor disease progression is rapid and...

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Bibliographic Details
Published in:Acta neurochirurgica 2018-05, Vol.160 (5), p.1073-1077
Main Authors: Woo, Peter Y. M., Zhuang, James T. F., Ho, Jason M. K., Seto, Andrew, Wong, Hoi-Tung, Chan, Kwong-Yau
Format: Article
Language:English
Subjects:
Brain cancer
Brain tumors
Case Report - Brain Tumors
Catheters
Cerebrospinal fluid
Complications
Consciousness
Drug dosages
Fibrin
Glioblastoma
Hydrocephalus
Interventional Radiology
Intracranial pressure
Magnetic resonance imaging
Medical prognosis
Medicine
Medicine & Public Health
Meninges
Minimally Invasive Surgery
Neurology
Neuroradiology
Neurosurgery
Patients
Proteins
Surgical Orthopedics
Tumors
U-Plasminogen activator
Urokinase
Ventriculoperitoneal shunt
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Summary:Leptomeningeal spread and hydrocephalus are increasingly recognized as late disease complications of glioblastoma with almost a quarter of patients requiring early cerebrospinal fluid shunting. The neurosurgeon is challenged with maintaining shunt patency when tumor disease progression is rapid and adjuvant oncologic therapy has yet to be initiated. We describe our experience in treating a young female with diffuse glioblastoma leptomeningeal spread and communicating hydrocephalus who had several episodes of shunt obstruction due to intraluminal tumor cell-fibrin deposits. Regular intraventricular instillations of urokinase fibrinolytic therapy not only re-established shunt patency but also contributed to the resolution of her hydrocephalus.
ISSN:0001-6268
0942-0940
DOI:10.1007/s00701-018-3509-9