Placement of cesium-131 permanent brachytherapy seeds in periventricular high-grade gliomas: case report highlighting a novel technique to prevent seed migration. Illustrative cases.

A Gabriella Wernicke, Julianna Cavallaro, Faina Ablyazova, Ching-Ling Teng, Anurag Sharma, Jake McDermott, John A Boockvar
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Abstract

Background: Reirradiation of recurrent high-grade gliomas (HGGs) with external beam radiation therapy is limited by the risk of radiation necrosis (RN). Intraoperative brachytherapy offers a localized radiation approach that minimizes RN risk while maintaining tumor control. However, seed migration has historically limited its use in periventricular regions. The authors present 3 cases of recurrent periventricular HGG (2 IDH-wildtype, MGMT promoter-methylated, EGFR-amplified WHO grade 4 glioblastoma and 1 WHO grade 3 astrocytoma) in which a three-layered barrier was created between the ventricular lining and tumor cavity to prevent seed migration, enabling successful brachytherapy.

Observations: Following maximal safe resection, a three-layered patch separated the resection cavity from the ventricle prior to cesium-131 (131Cs) brachytherapy. Patient 1 received suture-stranded 131Cs (20 seeds), while patients 2 and 3 received 131Cs GammaTile (6 tiles, 4 seeds per tile). A three-layered barrier was formed using Gelfoam, Surgicel, and Adherus. At a median 22-month (range 11-24 months) follow-up, MRI confirmed no seed migration and seeds remained in the cavity. There were no complications associated with the barrier placement.

Lessons: This study highlights the novel use of this technique in preventing 131Cs seed migration in intraoperative brachytherapy, serving as a proof-of-concept study. https://thejns.org/doi/10.3171/CASE25176.

在脑室周围高级别胶质瘤中放置铯-131永久近距离治疗种子:病例报告强调了一种防止种子迁移的新技术。说明情况。
背景:外束放射治疗复发性高级别胶质瘤(HGGs)的再照射受到放射性坏死(RN)风险的限制。术中近距离放疗提供了一种局部放疗方法,在保持肿瘤控制的同时将RN风险降至最低。然而,种子迁移历来限制了其在心室周围区域的应用。作者报告了3例复发性脑室周围HGG(2例idh野生型,MGMT启动子甲基化,egfr扩增的WHO级4级胶质母细胞瘤和1例WHO级3级星形细胞瘤),其中在脑室内膜和肿瘤腔之间建立了三层屏障以防止种子迁移,使近距离治疗成功。观察:在最大安全切除后,在铯-131 (131c)近距离治疗前,用三层贴片将切除腔与脑室分开。患者1接受缝线缠绕131c(20粒),患者2和患者3接受131c GammaTile(6片,每片4粒)。使用明胶泡沫、外科胶凝剂和粘附剂形成三层屏障。在中位22个月(11-24个月)的随访中,MRI证实种子未迁移,种子仍留在腔内。没有与屏障放置相关的并发症。经验教训:本研究强调了该技术在术中近距离治疗中防止131c粒子迁移的新应用,作为一项概念验证研究。https://thejns.org/doi/10.3171/CASE25176。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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