Symptomatic Remote Cyst after BCNU Wafer Implantation for Malignant Glioma

A 43-year-old man was operated on for right frontal oligoastrocytoma. 14 years after the surgery, magnetic resonance imaging and positron emission tomography revealed a new lesion near the surgical cavity. He underwent gross total resection of the lesion and implantation of bis-chloroethylnitrosoure...

Full description

Saved in:
Bibliographic Details
Published in:Neurologia medico-chirurgica 2018, Vol.58(6), pp.270-276
Main Authors: MATSUMURA, Hideaki, ISHIKAWA, Eiichi, MATSUDA, Masahide, SAKAMOTO, Noriaki, AKUTSU, Hiroyoshi, TAKANO, Shingo, MATSUMURA, Akira
Format: Article
Language:eng ; jpn
Subjects:
BCNU wafers
Brain cancer
carmustine wafers
Case Report
Computed tomography
Consciousness
cyst formation
Cysts
Glioma
Inflammation
Magnetic resonance imaging
malignant glioma
Neuroimaging
Oligoastrocytoma
Parenchyma
Paresis
Positron emission tomography
Rehabilitation
Surgery
symptomatic remote cyst
Tomography
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:A 43-year-old man was operated on for right frontal oligoastrocytoma. 14 years after the surgery, magnetic resonance imaging and positron emission tomography revealed a new lesion near the surgical cavity. He underwent gross total resection of the lesion and implantation of bis-chloroethylnitrosourea (BCNU) wafers after intraoperative pathological diagnosis of recurrent high-grade glioma. A few days after the operation, the level of consciousness gradually worsened and left hemiparesis developed. A computed tomography scan revealed a cyst remote to the surgical cavity which did not exist 3 days prior. We performed anterior cyst wall fenestration and removed all wafers. The characteristic pathological finding at the wafer implantation site was severe inflammation within and around small vessels. This inflammatory reaction was not seen on the surface of the brain parenchyma. After surgery and rehabilitation, the patient’s Karnofsky Performance Status stabilized to a pre-incident score of 90 and he returned to work. The exact pathophysiological mechanism of the cyst was not clear, but check-valve and/or osmotic gradient mechanisms related to BCNU wafer implantation could have contributed to this phenomenon. As remote cyst development happened a week after surgery, surgeons should be aware of such a rare condition when implanting wafers as consciousness impairment and hemiparesis may occur. Close radiological follow-up is therefore necessary.
ISSN:0470-8105
1349-8029
DOI:10.2176/nmc.cr.2017-0218