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Review
. 2025 Jun 2:5:104292.
doi: 10.1016/j.bas.2025.104292. eCollection 2025.

Inadvertent intrathecal application of vindesine and its neurological outcome: case report and systematic review of the literature

A Babaee  1 , H Yasin  1 , B Berger  2 , M Simon  1
Affiliations
Review

Inadvertent intrathecal application of vindesine and its neurological outcome: case report and systematic review of the literature

A Babaee et al. Brain Spine. .

Abstract

Introduction: Vinca alkaloids are used to treat a diversity of malignancies. Inadvertent intrathecal application is followed by severe neurological consequences, with fatal outcomes in the majority of the reported cases. Therapy of choice has been experimental.

Research question: What are the outcomes of inadvertent intrathecal application of vinca alkaloids and how should it be treated? What is the role of irrigation of the cerebrospinal fluid (CSF) in order to remove the vinca alkaloid and potentially toxic metabolites?

Material and methods: In this paper we report the case of a 53-year-old man who was, in the course of his treatment for acute lymphoblastic leukemia (ALL), inadvertently injected with vindesine intrathecally. The patient survived following aggressive and invasive treatment, which included irrigation of the CSF via external ventricular and lumbar drains. We also conducted a systematic review of similar published cases.

Result: A total of 31 cases with intrathecal inadvertent vinca alkaloid injection were identified. Including the case described in this report only two patients were injected with vindesine (n = 2, 6.5 %), all other received vincristine. Only 6/31 (19.4 %) patients survived the acute phase of the vinca alkaloid intoxication. 6/15 (40.0 %) patients receiving some sort of CSF irrigation survived (cf. 0/12 without irrigation therapy). All survivors were left with very significant neurological deficits.

Discussion and conclusion: The combined evidence suggests that intrathecal administration of vincristine is universally fatal without treatment, while CSF irrigation carries a chance of survival. Patients are, however, left with severe neurological deficits such as paraplegia.

Keywords: Case report; Intrathecal; Vincristine; inadvertent; vindesine.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Timeline of the patient's clinical course.
Fig. 2a
Fig. 2a
T2 weighted MRI images of the lumbar spine on day 1 (left) and day 14 (right). On day 14, a possible new hyperintense signal (“myelopathy”) in the conus medullaris is seen.
Fig. 2b
Fig. 2b
Contrast-enhanced T1 weighted MRI image of the lumbar spine on day 1 (left) and day 14 (right). The repeat scan shows new diffuse contrast enhancement of the cauda equina (“polyradiculopathy”).
Fig. 3
Fig. 3
PRISMA flowchart of the systematic review.
See this image and copyright information in PMC

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