International Brain Tumour Awareness Week
Saturday, 24th October to Saturday, 31st October 2020
Intrathecal / Intra-cerebrospinal fluid (CSF) administration
Intrathecal (also known as intra-CSF) administration is where chemotherapy is given directly into the cerebrospinal space (the area surrounding the spine and brain).
Access is either via lumbar puncture (during which a needle is placed into the cerebrospinal space in between two vertebrae) or through an Ommaya reservoir. An Ommaya reservoir consists of a small port that is placed underneath the skin on the head, which is attached to a catheter that is threaded into the site of CSF production in the brain. This latter route is preferable if patients need prolonged or repeated treatment.
The Ommaya reservoir option appears to give a more even distribution of high amounts of drug in the CSF compared with lumbar puncture. However, very little drug penetrates the brain, which can limit the effectiveness of the treatment against brain tumours.
Intrathecal chemotherapy has been safely and widely practiced in the treatment of some paediatric tumours, notably childhood lymphoma and acute lymphoblastic leukaemia. It is a particularly attractive option for treating spread of brain tumours into the leptomeninges (thin layers of tissue which cover the brain and spinal cord).
However, we need to establish devices and techniques to deliver the therapy more easily, and to enable prolonged drug infusions or drug preparations that release drug over a sustained period of time (i.e. several weeks to months).
Video courtesy of jtv cancer support.