Symptomatic Remote Cyst after BCNU Wafer Implantation for Malignant Glioma

• DOI: 10.2176/nmc.cr.2017-0218
• Publication Date: 2018-05-20T18:30:40Z
• Authors: Hideaki MATSUMURA; Eiichi ISHIKAWA; Masahide MATSUDA; Noriaki SAKAMOTO; Hiroyoshi AKUTSU; Shingo TAKANO; Akira MATSUMURA
• Keywords: Hemiparesis

A 43-year-old man was operated on for right frontal oligoastrocytoma. 14 years after the surgery, magnetic resonance imaging and positron emission tomography revealed a new lesion near surgical cavity. He underwent gross total resection of implantation bis-chloroethylnitrosourea (BCNU) wafers intraoperative pathological diagnosis recurrent high-grade glioma. few days operation, level consciousness gradually worsened left hemiparesis developed. computed scan cyst remote to cavity which did not exist 3 prior. We performed anterior wall fenestration removed all wafers. The characteristic finding at wafer site severe inflammation within around small vessels. This inflammatory reaction seen surface brain parenchyma. After surgery rehabilitation, patient’s Karnofsky Performance Status stabilized pre-incident score 90 he returned work. exact pathophysiological mechanism clear, but check-valve and/or osmotic gradient mechanisms related BCNU could have contributed this phenomenon. As development happened week surgeons should be aware such rare condition when implanting as impairment may occur. Close radiological follow-up is therefore necessary.