Peer-reviewed article
DDEL-03. The use of programmable valves as a vehicle for intrathecal chemotherapy delivery in infants with CNS tumors and hydrocephalus.
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Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This is a medical case series describing a clinical technique for delivering chemotherapy to infants with brain tumors and hydrocephalus using programmable valves. Five infants aged 1-3 years received 61 chemotherapy administrations through modified shunt valves with minimal complications. While this addresses a serious pediatric medical condition, it is a technical clinical innovation rather than an evaluation of an intervention for child well-being outcomes.
Key points
- Five infants with CNS malignancies and concurrent hydrocephalus were treated using programmable valves for intrathecal chemotherapy delivery
- 61 total chemotherapeutic administrations were performed with no infections, leaks, or major complications
- Only one child required sedation; most procedures were conducted in outpatient settings
- The technique potentially eliminates the need for an additional ventricular access device
Limitations
This is a small retrospective case series of only five infants with no comparison group and no long-term survival or disease outcome data. The document does not evaluate whether this delivery method improves treatment effectiveness or child survival compared to standard methods.
Abstract
Abstract INTRODUCTION: Current chemotherapy protocols for treatment of embryonal brain tumors in infants recommend administration of intrathecal chemotherapy either by a lumbar tap or via an Ommaya reservoir. Children with concurrent hydrocephalus and shunts may have sub-therapeutic levels of chemotherapy in the CSF due to constant CSF drainage to extra-CNS compartments. We present our experience in delivery of chemotherapy to young children via programmable valves. RESULTS: A retrospective analysis of infants with CNS malignancies and hydrocephalus treated with a shunt and a programmable valve (CERTAS™ Plus Programmable Valves - Integra Life Sciences) was conducted. Five infants 1.1-3 years of age (mean 2) were included. Pathologies included atypical teratoid rhabdoid tumor (ATRT N=2), medulloblastoma (N=2), and metastatic rhabdomyosarcoma(N=1). Intrathecal injections were conducted in an outpatient setting unless hospitalization was required for other reasons. Only one child required sedation due to noncompliance. A total of 61 chemotherapeutic administrations were performed directly through the valve while set on an extremely high opening pressure for several hours( 35 with hydrocortisone and cytarabine, 26 with topotecan). There were no infections, leaks or major complications. One child required a wound revision due to exposure of the proximal catheter related to extremely thin skin, one child developed somnolence and fever which were not related to a shunt malfunction or infection, and one child had clinical and radiological shunt over-drainage solved by increasing of valve settings. CONCLUSIONS: Programmable ventriculoperitoneal valves appear to a safe method for delivery of chemotherapy in infants with malignant CNS tumors .This technique may potentially have an added value for children with concurrent shunts, and may also obviate the need for an additional ventricular access device .