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OtherNeurointervention

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

David Fortin, Joseph A. Salamé, Annick Desjardins and Andrew Benko
American Journal of Neuroradiology May 2004, 25 (5) 830-834;
David Fortin
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Joseph A. Salamé
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Annick Desjardins
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Andrew Benko
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    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.

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    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.

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    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.

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    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.

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    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.

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American Journal of Neuroradiology: 25 (5)
American Journal of Neuroradiology
Vol. 25, Issue 5
1 May 2004
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Cite this article
David Fortin, Joseph A. Salamé, Annick Desjardins, Andrew Benko
Technical Modification in the Intracarotid Chemotherapy and Osmotic Blood-Brain Barrier Disruption Procedure to Prevent the Relapse of Carboplatin-Induced Orbital Pseudotumor
American Journal of Neuroradiology May 2004, 25 (5) 830-834;

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Technical Modification in the Intracarotid Chemotherapy and Osmotic Blood-Brain Barrier Disruption Procedure to Prevent the Relapse of Carboplatin-Induced Orbital Pseudotumor
David Fortin, Joseph A. Salamé, Annick Desjardins, Andrew Benko
American Journal of Neuroradiology May 2004, 25 (5) 830-834;
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  • Risk factors for idiopathic orbital inflammation: a case-control study
  • Maculopathy in patients with primary CNS lymphoma treated with chemotherapy in conjunction with blood-brain barrier disruption
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