Supraophthalmic chemotherapy with long tapered catheter: distribution evaluated with intraarterial and intravenous Tc-99m HMPAO

Abstract

Supraophthalmic intraarterial chemotherapy has not become popular due to a high incidence of damage to the normal brain and eye. This damage is due to inhomogeneous distribution of the agent secondary to streaming and other flow-related phenomena. To try to minimize this complication, the authors developed a catheter and studied different infusion techniques. A 4.5-F catheter tapered to 2.5 F was used to perform supraophthalmic intraarterial chemotherapy in 26 patients with malignant gliomas. Forty-one of 45 catheterizations were successful. In 17 patients (20 procedures), technetium-99m hexamethyl-propyleneamine oxime (HMPAO) was then injected through the catheter and single photon emission computed tomography was performed to assess the cerebral distribution of the radiopharmaceutical with either a pulsatile or continuous infusion technique. Diffuse and relatively homogeneous distribution of Tc-99m HMPAO was observed with fast pulsatile infusion (10 of 10 procedures); however, inhomogeneous distribution was mostly seen with slow continuous infusion (eight of 10 procedures).