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Double-edged Sword in the Placement of Carmustine (BCNU) Wafers along the Eloquent Area: A Case Report

Although direct Gliadel(®) wafer implantation into the resection cavity has been shown to significantly improve survival in patients with high-grade gliomas, several complications have been associated with the implantations of Gliadel wafers, including brain edema, healing delay, cerebral spinal flu...

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Autores principales: Kuramitsu, Shunichiro, Motomura, Kazuya, Natsume, Atsushi, Wakabayashi, Toshihiko
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The Japan Neurosurgical Society 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5364933/
https://www.ncbi.nlm.nih.gov/pubmed/28663961
http://dx.doi.org/10.2176/nmccrj.2014-0025
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author Kuramitsu, Shunichiro
Motomura, Kazuya
Natsume, Atsushi
Wakabayashi, Toshihiko
author_facet Kuramitsu, Shunichiro
Motomura, Kazuya
Natsume, Atsushi
Wakabayashi, Toshihiko
author_sort Kuramitsu, Shunichiro
collection PubMed
description Although direct Gliadel(®) wafer implantation into the resection cavity has been shown to significantly improve survival in patients with high-grade gliomas, several complications have been associated with the implantations of Gliadel wafers, including brain edema, healing delay, cerebral spinal fluid leak, intracranial infections, and cyst formation. The brain edema that is associated with Gliadel wafer implantation might result in neurological deficits and significant morbidities and mortalities. In particular, it is not clear if they should be placed in the eloquent areas, such as language areas, motor areas, and areas related to cognitive function, even if these areas contain a remnant tumor. Here, we present a case of profound brain edema along the pyramidal tract due to Gliadel wafer implantation, which resulted in severe neurological deficits. This treatment represents a double-edged sword due to the possibility of severe symptomatic brain edema along the eloquent area, even though Gliadel wafers might be effective in controlling local tumor growth. We should keep in mind that Gliadel wafer placement in eloquent areas may result in severe disadvantages to patients and a loss of their quality of life.
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spelling pubmed-53649332017-06-29 Double-edged Sword in the Placement of Carmustine (BCNU) Wafers along the Eloquent Area: A Case Report Kuramitsu, Shunichiro Motomura, Kazuya Natsume, Atsushi Wakabayashi, Toshihiko NMC Case Rep J Case Report Although direct Gliadel(®) wafer implantation into the resection cavity has been shown to significantly improve survival in patients with high-grade gliomas, several complications have been associated with the implantations of Gliadel wafers, including brain edema, healing delay, cerebral spinal fluid leak, intracranial infections, and cyst formation. The brain edema that is associated with Gliadel wafer implantation might result in neurological deficits and significant morbidities and mortalities. In particular, it is not clear if they should be placed in the eloquent areas, such as language areas, motor areas, and areas related to cognitive function, even if these areas contain a remnant tumor. Here, we present a case of profound brain edema along the pyramidal tract due to Gliadel wafer implantation, which resulted in severe neurological deficits. This treatment represents a double-edged sword due to the possibility of severe symptomatic brain edema along the eloquent area, even though Gliadel wafers might be effective in controlling local tumor growth. We should keep in mind that Gliadel wafer placement in eloquent areas may result in severe disadvantages to patients and a loss of their quality of life. The Japan Neurosurgical Society 2014-10-08 /pmc/articles/PMC5364933/ /pubmed/28663961 http://dx.doi.org/10.2176/nmccrj.2014-0025 Text en © 2015 The Japan Neurosurgical Society This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-nd/4.0/
spellingShingle Case Report
Kuramitsu, Shunichiro
Motomura, Kazuya
Natsume, Atsushi
Wakabayashi, Toshihiko
Double-edged Sword in the Placement of Carmustine (BCNU) Wafers along the Eloquent Area: A Case Report
title Double-edged Sword in the Placement of Carmustine (BCNU) Wafers along the Eloquent Area: A Case Report
title_full Double-edged Sword in the Placement of Carmustine (BCNU) Wafers along the Eloquent Area: A Case Report
title_fullStr Double-edged Sword in the Placement of Carmustine (BCNU) Wafers along the Eloquent Area: A Case Report
title_full_unstemmed Double-edged Sword in the Placement of Carmustine (BCNU) Wafers along the Eloquent Area: A Case Report
title_short Double-edged Sword in the Placement of Carmustine (BCNU) Wafers along the Eloquent Area: A Case Report
title_sort double-edged sword in the placement of carmustine (bcnu) wafers along the eloquent area: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5364933/
https://www.ncbi.nlm.nih.gov/pubmed/28663961
http://dx.doi.org/10.2176/nmccrj.2014-0025
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