{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,9]],"date-time":"2026-05-09T09:14:45Z","timestamp":1778318085719,"version":"3.51.4"},"reference-count":52,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,1]]},"abstract":"\n OBJECTIVE<\/jats:title>\n In the brainstem, there are concerns regarding volumetric alterations following convection-enhanced delivery (CED). The relationship between distribution volume and infusion volume is predictably greater than one. Whether this translates into deformational changes and influences clinical management is unknown. As part of a trial using CED for diffuse intrinsic pontine glioma (DIPG), the authors measured treatment-related volumetric alterations in the brainstem and ventricles.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n \n Enrolled patients underwent a single infusion of radioimmunotherapy. Between 2012 and 2019, 23 patients with volumetric pre- and postoperative day 1 (POD1) and day 30 (POD30) MRI scans were analyzed using iPlan\n \u00ae<\/jats:sup>\n Flow software for semiautomated volumetric measurements of the ventricles and pontine segment of the brainstem.\n <\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n \n Children in the study had a mean age of 7.7 years (range 2\u201318 years). The mean infusion volume was 3.9 \u00b1 1.7 ml (range 0.8\u20138.8 ml). Paired t-tests demonstrated a significant increase in pontine volume immediately following infusion (p < 0.0001), which trended back toward baseline by POD30 (p = 0.046; preoperative 27.6 \u00b1 8.4 ml, POD1 30.2 \u00b1 9.0 ml, POD30 29.5 \u00b1 9.4 ml). Lateral ventricle volume increased (p = 0.02) and remained elevated on POD30 (p = 0.04; preoperative 23.5 \u00b1 15.4 ml, POD1 26.3 \u00b1 16.0, POD30 28.6 \u00b1 21.2). Infusion volume had a weak, positive correlation with pontine and lateral ventricle volume change (r\n 2<\/jats:sup>\n = 0.22 and 0.27, respectively). Four of the 23 patients had an increase in preoperative neurological deficits at POD30. No patients required shunt placement within 90 days.\n <\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n CED infusion into the brainstem correlates with immediate but self-limited deformation changes in the pons. The persistence of increased ventricular volume and no need for CSF diversion post-CED are inconsistent with obstructive hydrocephalus. Defining the degree and time course of these deformational changes can assist in the interpretation of neuroimaging along the DIPG disease continuum when CED is incorporated into the treatment algorithm.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2019.10.focus19679","type":"journal-article","created":{"date-parts":[[2020,1,3]],"date-time":"2020-01-03T18:29:41Z","timestamp":1578076181000},"page":"E3","source":"Crossref","is-referenced-by-count":12,"title":["Deformational changes after convection-enhanced delivery in the pediatric brainstem"],"prefix":"10.3171","volume":"48","author":[{"given":"Evan D.","family":"Bander","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, Weill Medical College of Cornell University, New York, New York;"},{"name":"Department of Neurological Surgery, Memorial Sloan Kettering Cancer Center, New York, New York;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karima","family":"Tizi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, H\u00f4pitaux Universitaires de Gen\u00e8ve, Geneva, Switzerland; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eva","family":"Wembacher-Schroeder","sequence":"additional","affiliation":[{"name":"Brainlab AG, Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rowena","family":"Thomson","sequence":"additional","affiliation":[{"name":"Brainlab AG, Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria","family":"Donzelli","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Memorial Sloan Kettering Cancer Center, New York, New York;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth","family":"Vasconcellos","sequence":"additional","affiliation":[{"name":"Brainlab AG, Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark M.","family":"Souweidane","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Weill Medical College of Cornell University, New York, New York;"},{"name":"Department of Neurological Surgery, Memorial Sloan Kettering Cancer Center, New York, New York;"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1","series-title":"J Neurosurg Pediatr","doi-asserted-by":"publisher","first-page":"289","DOI":"10.3171\/2012.10.PEDS12142","article-title":"Convection-enhanced delivery of topotecan into diffuse intrinsic brainstem tumors in children","volume":"11","author":"Anderson RCE","year":"2013","unstructured":"Anderson RCE, Kennedy B, Yanes CL, Garvin J, Needle M, Canoll P, : Convection-enhanced delivery of topotecan into diffuse intrinsic brainstem tumors in children. 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