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Case Reports
. 2014 Sep 29;2(1):36-39.
doi: 10.2176/nmccrj.2014-0080. eCollection 2015 Jan.

Cerebral Infarction Related to Carmustine Wafers in Glioblastoma: A Case Report

Mitsutoshi Nakada  1 , Shingo Tanaka  1 , Masahiro Oishi  1 , Katsuyoshi Miyashita  1 , Kouichi Misaki  1 , Masanao Mohri  1 , Yasuhiko Hayashi  1 , Naoyuki Uchiyama  1 , Takuya Watanabe  1 , Yutaka Hayashi  1
Affiliations
Case Reports

Cerebral Infarction Related to Carmustine Wafers in Glioblastoma: A Case Report

Mitsutoshi Nakada et al. NMC Case Rep J. .

Abstract

Implantation of carmustine-impregnated wafers (Gliadel®) into the tumor resection cavity has demonstrated a survival benefit for patients with malignant glioma. However, some precautions should be taken regarding Gliadel implantation. We report a case of a 63-year-old man with glioblastoma who was implanted with Gliadel after a left temporal lobe tumor had been removed, and who later developed vasospasm of the lenticulostriate artery close to the implanted Gliadel, leading to serious cerebral infarction. Therefore, the implantation of Gliadel in cases where important vessels run close to the resection cavity should be considered with great caution.

Keywords: carmustine; cerebral infarction; glioblastoma; vasospasm.

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Conflict of interest statement

Conflicts of Interest Disclosure The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices in the article. All authors who members of The Japan Neurosurgical Society (JNS) have registered online Self-reported COI Disclosure Statement Forms through the website for JNS members.

Figures

Fig. 1
Fig. 1
CT and MRI findings pre-operatively (A–C), at day 1 after the operation (D–F), and at day 12 (G–I). A: CT with contrast medium showing a ring-enhanced mass with irregular margins (diameter, 40 mm) in the temporal lobe and insula. B: T2-weighted image showing a hyperintense lesion. C, F: Diffusion-weighted MRI (DWI) showing no hyperintense lesions. D: CT showing entrapped air in the resected cavity (arrows). E: T2-weighted image showing mild perifocal edema and subdural air. G: CT showing enlargement of entrapped air in the resected cavity (arrows) with perifocal edema (arrowheads). H: T2-weighted images showing severe edema. I: DWI showing a hyperintense lesion in the left corona radiata, suggesting acute cerebral infarction. CECT: contrast-enhanced computed tomography, CT: computed tomography, MRI: magnetic resonance imaging.
Fig. 2
Fig. 2
Intraoperative pictures (A–C) and postoperative MRI at day 1 (D, E). A: Tumor resected cavity before implantation of Gliadel. B: The location of Gliadel in high magnification (C) and low magnification. Axial (D) and coronal (E) image on T1-weighted image showing the location of Gliadel (arrows). MRI: magnetic resonance imaging.
Fig. 3
Fig. 3
Angiographic findings at day 13 (A, B) and day 39 (C, D). A: Digital subtraction angiography (DSA): left internal carotid artery injection (AP view) showing stenosis of a major branch of lenticulostriate arteries (LSAs, arrow). B: Reformatted coronal image of three-dimensional rotational angiography (3DRA) showing stenosis of the left LSA (arrow) below the air related to Gliadel (arrowhead). C: DSA showing recovery of LSA stenosis. D: Reformatted coronal image of 3DRA showing no stenosis and disappearance of air.
See this image and copyright information in PMC

References

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