{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,21]],"date-time":"2026-02-21T21:04:28Z","timestamp":1771707868449,"version":"3.50.1"},"reference-count":22,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,9]]},"abstract":"<jats:p>Convection-enhanced delivery (CED) uses positive pressure to induce convective flow of molecules and maximize drug distribution. Concerns have been raised about the effect of cystic structures on uniform drug distribution with CED. The authors describe the case of a patient with a diffuse intrinsic pontine glioma (DIPG) with a large cyst and examine its effect on drug distribution after CED with a radiolabeled antibody. The patient was treated according to protocol with CED of <jats:sup>124<\/jats:sup>I-8H9 to the pons for nonprogressive DIPG after radiation therapy as part of a Phase I trial (clinical trial registration no. NCT01502917, clinicaltrials.gov). Care was taken to avoid the cystic cavity in the planned catheter track and target point. Co-infusion with Gd-DTPA was performed to assess drug distribution. Infusate distribution was examined by MRI immediately following infusion and analyzed using iPlan Flow software. Analysis of postinfusion MR images demonstrated convective distribution around the catheter tip and an elongated configuration of drug distribution, consistent with the superoinferior corticospinal fiber orientation in the brainstem. This indicates that the catheter was functioning and a pressure gradient was established. No infusate entry into the cystic region could be identified on T2-weighted FLAIR or T1-weighted images. The effects of ependymal and pial surfaces on drug delivery using CED in brainstem tumors remain controversial. Drug distribution is a critical component of effective application of CED to neurosurgical lesions. This case suggests that cyst cavities may not always behave as fluid \u201csinks\u201d for drug distribution. The authors observed that infusate was not lost into the cyst cavity, suggesting that lesions with cystic components can be treated by CED without significant alterations to target and infusion planning.<\/jats:p>","DOI":"10.3171\/2017.5.peds1774","type":"journal-article","created":{"date-parts":[[2017,7,7]],"date-time":"2017-07-07T14:02:01Z","timestamp":1499436121000},"page":"256-260","source":"Crossref","is-referenced-by-count":9,"title":["Influence of an intratumoral cyst on drug distribution by convection-enhanced delivery: case report"],"prefix":"10.3171","volume":"20","author":[{"given":"Iryna","family":"Ivasyk","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, NewYork-Presbyterian Hospital, Weill Cornell Medicine;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter F.","family":"Morgenstern","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, NewYork-Presbyterian Hospital, Weill Cornell Medicine;"},{"name":"Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, New York; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eva","family":"Wembacher-Schroeder","sequence":"additional","affiliation":[{"name":"Brainlab, Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark M.","family":"Souweidane","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, NewYork-Presbyterian Hospital, Weill Cornell Medicine;"},{"name":"Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, New York; and"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1","series-title":"Neuro Oncol","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1215\/15228517-2005-007","article-title":"Isolation of drug delivery from drug effect: problems of optimizing drug delivery parameters","volume":"8","author":"Ali MJ","year":"2006","unstructured":"Ali MJ, Navalitloha Y, Vavra MW, Kang EW, Itskovich AC, Molnar P, : Isolation of drug delivery from drug effect: problems of optimizing drug delivery parameters. Neuro Oncol 8:109\u2013118, 200610.1215\/15228517-2005-00716533759"},{"key":"b2","series-title":"Acta Neurochir (Wien)","doi-asserted-by":"publisher","first-page":"1459","DOI":"10.1007\/s00701-013-1700-6","article-title":"Robot-guided convection-enhanced delivery of carboplatin for advanced brainstem glioma","volume":"155","author":"Barua NU","year":"2013","unstructured":"Barua NU, Lowis SP, Woolley M, O\u2019Sullivan S, Harrison R, Gill SS: Robot-guided convection-enhanced delivery of carboplatin for advanced brainstem glioma. Acta Neurochir (Wien) 155:1459\u20131465, 201310.1007\/s00701-013-1700-623595829"},{"key":"b3","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"298","DOI":"10.1227\/00006123-198303000-00008","article-title":"Pediatric brain stem tumors: radiographic, pathological, and clinical correlations","volume":"12","author":"Berger MS","year":"1983","unstructured":"Berger MS, Edwards MS, LaMasters D, Davis RL, Wilson CB: Pediatric brain stem tumors: radiographic, pathological, and clinical correlations. Neurosurgery 12:298\u2013302, 198310.1227\/00006123-198303000-000086302553"},{"key":"b4","series-title":"Acta Neuropathol","doi-asserted-by":"publisher","first-page":"815","DOI":"10.1007\/s00401-015-1478-0","article-title":"Histone H3F3A and HIST1H3B K27M mutations define two subgroups of diffuse intrinsic pontine gliomas with different prognosis and phenotypes","volume":"130","author":"Castel D","year":"2015","unstructured":"Castel D, Philippe C, Calmon R, Le Dret L, Truffaux N, Boddaert N, : Histone H3F3A and HIST1H3B K27M mutations define two subgroups of diffuse intrinsic pontine gliomas with different prognosis and phenotypes. Acta Neuropathol 130:815\u2013827, 20152639963110.1007\/s00401-015-1478-0"},{"key":"b5","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"1173","DOI":"10.3171\/2014.11.JNS131888","article-title":"Accuracy of direct magnetic resonance imaging-guided placement of drug infusion cannulae","volume":"122","author":"Chittiboina P","year":"2015","unstructured":"Chittiboina P, Heiss JD, Lonser RR: Accuracy of direct magnetic resonance imaging-guided placement of drug infusion cannulae. J Neurosurg 122:1173\u20131179, 20152559432510.3171\/2014.11.JNS131888"},{"key":"b6","series-title":"J Neurooncol","doi-asserted-by":"publisher","first-page":"309","DOI":"10.1007\/BF00177425","article-title":"Intrinsic brainstem tumors in childhood: surgical indications","volume":"6","author":"Epstein F","year":"1988","unstructured":"Epstein F, Wisoff JH: Intrinsic brainstem tumors in childhood: surgical indications. J Neurooncol 6:309\u2013317, 198810.1007\/BF001774253221258"},{"key":"b7","series-title":"Clin Neurol Neurosurg","doi-asserted-by":"publisher","first-page":"120","DOI":"10.1016\/j.clineuro.2016.01.007","article-title":"Local delivery methods of therapeutic agents in the treatment of diffuse intrinsic brainstem gliomas","volume":"142","author":"Goodwin CR","year":"2016","unstructured":"Goodwin CR, Xu R, Iyer R, Sankey EW, Liu A, Abu-Bonsrah N, : Local delivery methods of therapeutic agents in the treatment of diffuse intrinsic brainstem gliomas. Clin Neurol Neurosurg 142:120\u2013127, 20162684984010.1016\/j.clineuro.2016.01.007"},{"key":"b8","series-title":"Curr Oncol Rep","doi-asserted-by":"publisher","first-page":"436","DOI":"10.1007\/s11912-014-0436-7","article-title":"Pediatric brainstem gliomas: new understanding leads to potential new treatments for two very different tumors","volume":"17","author":"Green AL","year":"2015","unstructured":"Green AL, Kieran MW: Pediatric brainstem gliomas: new understanding leads to potential new treatments for two very different tumors. Curr Oncol Rep 17:436, 201510.1007\/s11912-014-0436-725702179"},{"key":"b9","series-title":"Neuro Oncol","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1093\/neuonc\/2.1.45","article-title":"The blood-brain and blood-tumor barriers: a review of strategies for increasing drug delivery","volume":"2","author":"Groothuis DR","year":"2000","unstructured":"Groothuis DR: The blood-brain and blood-tumor barriers: a review of strategies for increasing drug delivery. Neuro Oncol 2:45\u201359, 200010.1093\/neuonc\/2.1.4511302254"},{"key":"b10","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"547","DOI":"10.3171\/JNS\/2008\/109\/9\/0547","article-title":"Effect of ependymal and pial surfaces on convection-enhanced delivery","volume":"109","author":"Jagannathan J","year":"2008","unstructured":"Jagannathan J, Walbridge S, Butman JA, Oldfield EH, Lonser RR: Effect of ependymal and pial surfaces on convection-enhanced delivery. J Neurosurg 109:547\u2013552, 200810.3171\/JNS\/2008\/109\/9\/054718759589"},{"key":"b11","series-title":"Cancer","doi-asserted-by":"publisher","first-page":"2787","DOI":"10.1002\/1097-0142(19800601)45:11<2787::AID-CNCR2820451113>3.0.CO;2-V","article-title":"Pediatric brain stem gliomas","volume":"45","author":"Littman P","year":"1980","unstructured":"Littman P, Jarrett P, Bilaniuk LT, Rorke LB, Zimmerman RA, Bruce DA, : Pediatric brain stem gliomas. Cancer 45:2787\u20132792, 1980737900910.1002\/1097-0142(19800601)45:11<2787::AID-CNCR2820451113>3.0.CO;2-V"},{"key":"b12","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"697","DOI":"10.3171\/2014.10.JNS14229","article-title":"Convection-enhanced delivery to the central nervous system","volume":"122","author":"Lonser RR","year":"2015","unstructured":"Lonser RR, Sarntinoranont M, Morrison PF, Oldfield EH: Convection-enhanced delivery to the central nervous system. J Neurosurg 122:697\u2013706, 20152539736510.3171\/2014.10.JNS14229"},{"key":"b13","series-title":"Neurology","doi-asserted-by":"publisher","first-page":"254","DOI":"10.1212\/01.wnl.0000247744.10990.e6","article-title":"Image-guided, direct convective delivery of glucocerebrosidase for neuronopathic Gaucher disease","volume":"68","author":"Lonser RR","year":"2007","unstructured":"Lonser RR, Schiffman R, Robison RA, Butman JA, Quezado Z, Walker ML, : Image-guided, direct convective delivery of glucocerebrosidase for neuronopathic Gaucher disease. Neurology 68:254\u2013261, 20071706559110.1212\/01.wnl.0000247744.10990.e6"},{"key":"b14","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"1243","DOI":"10.1227\/01.NEU.0000159649.71890.30","article-title":"Safety and feasibility of convection-enhanced delivery of Cotara for the treatment of malignant glioma: initial experience in 51 patients","volume":"56","author":"Patel SJ","year":"2005","unstructured":"Patel SJ, Shapiro WR, Laske DW, Jensen RL, Asher AL, Wessels BW, : Safety and feasibility of convection-enhanced delivery of Cotara for the treatment of malignant glioma: initial experience in 51 patients. Neurosurgery 56:1243\u20131253, 200510.1227\/01.NEU.0000159649.71890.3015918940"},{"key":"b15","series-title":"Stereotact Funct Neurosurg","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1159\/000323544","article-title":"Novel platform for MRI-guided convection-enhanced delivery of therapeutics: preclinical validation in nonhuman primate brain","volume":"89","author":"Richardson RM","year":"2011","unstructured":"Richardson RM, Kells AP, Martin AJ, Larson PS, Starr PA, Piferi PG, : Novel platform for MRI-guided convection-enhanced delivery of therapeutics: preclinical validation in nonhuman primate brain. Stereotact Funct Neurosurg 89:141\u2013151, 201110.1159\/00032354421494065"},{"key":"b16","series-title":"Neuroimage","doi-asserted-by":"publisher","first-page":"2423","DOI":"10.1016\/j.neuroimage.2011.08.107","article-title":"Analysis of a simulation algorithm for direct brain drug delivery","volume":"59","author":"Rosenbluth KH","year":"2012","unstructured":"Rosenbluth KH, Eschermann JF, Mittermeyer G, Thomson R, Mittermeyer S, Bankiewicz KS: Analysis of a simulation algorithm for direct brain drug delivery. Neuroimage 59:2423\u20132429, 20122194546810.1016\/j.neuroimage.2011.08.107"},{"key":"b17","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"301","DOI":"10.3171\/2009.11.JNS091052","article-title":"Poor drug distribution as a possible explanation for the results of the PRECISE trial","volume":"113","author":"Sampson JH","year":"2010","unstructured":"Sampson JH, Archer G, Pedain C, Wembacher-Schr\u00f6der E, Westphal M, Kunwar S, : Poor drug distribution as a possible explanation for the results of the PRECISE trial. J Neurosurg 113:301\u2013309, 201010.3171\/2009.11.JNS09105220020841"},{"issue":"2 Suppl 1","key":"b18","series-title":"Neurosurgery","first-page":"ONS89","article-title":"Intracerebral infusate distribution by convection-enhanced delivery in humans with malignant gliomas: descriptive effects of target anatomy and catheter positioning","volume":"60","author":"Sampson JH","year":"2007","unstructured":"Sampson JH, Brady ML, Petry NA, Croteau D, Friedman AH, Friedman HS, : Intracerebral infusate distribution by convection-enhanced delivery in humans with malignant gliomas: descriptive effects of target anatomy and catheter positioning. Neurosurgery 60 (2 Suppl 1):ONS89\u2013ONS99, 2007"},{"key":"b19","series-title":"Neuro Oncol","doi-asserted-by":"publisher","first-page":"343","DOI":"10.1215\/15228517-2007-007","article-title":"Clinical utility of a patient-specific algorithm for simulating intracerebral drug infusions","volume":"9","author":"Sampson JH","year":"2007","unstructured":"Sampson JH, Raghavan R, Brady ML, Provenzale JM, Herndon JE II, Croteau D, : Clinical utility of a patient-specific algorithm for simulating intracerebral drug infusions. Neuro Oncol 9:343\u2013353, 200710.1215\/15228517-2007-00717435179"},{"key":"b20","series-title":"World Neurosurg","doi-asserted-by":"publisher","first-page":"272","DOI":"10.1016\/j.wneu.2016.02.003","article-title":"Magnetic resonance imaging-based assessment of gadolinium-conjugated diethylenetriamine penta-acetic acid test-infusion in detecting dysfunction of convection-enhanced delivery catheters","volume":"89","author":"van Putten EH","year":"2016","unstructured":"van Putten EH, Wembacher-Schr\u00f6der E, Smits M, Dirven CM: Magnetic resonance imaging-based assessment of gadolinium-conjugated diethylenetriamine penta-acetic acid test-infusion in detecting dysfunction of convection-enhanced delivery catheters. World Neurosurg 89:272\u2013279, 201610.1016\/j.wneu.2016.02.003"},{"key":"b21","series-title":"Front Oncol","doi-asserted-by":"publisher","first-page":"237","DOI":"10.3389\/fonc.2015.00237","article-title":"DIPG in children \u2014 what can we learn from the past?","volume":"5","author":"Vanan MI","year":"2015","unstructured":"Vanan MI, Eisenstat DD: DIPG in children \u2014 what can we learn from the past? Front Oncol 5:237, 201510.3389\/fonc.2015.0023726557503"},{"key":"b22","series-title":"Arch Dis Child","doi-asserted-by":"publisher","first-page":"558","DOI":"10.1136\/adc.80.6.558","article-title":"Clinical management of brain stem glioma","volume":"80","author":"Walker DA","year":"1999","unstructured":"Walker DA, Punt JA, Sokal M: Clinical management of brain stem glioma. Arch Dis Child 80:558\u2013564, 199910.1136\/adc.80.6.55810332008"}],"container-title":["Journal of Neurosurgery: Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/20\/3\/article-p256.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/20\/3\/article-p256.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/20\/3\/article-p256.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,15]],"date-time":"2023-04-15T13:53:11Z","timestamp":1681566791000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/20\/3\/article-p256.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,9]]},"references-count":22,"journal-issue":{"issue":"3"},"URL":"https:\/\/doi.org\/10.3171\/2017.5.peds1774","relation":{},"ISSN":["1933-0707","1933-0715"],"issn-type":[{"value":"1933-0707","type":"print"},{"value":"1933-0715","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,9]]}}}