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Sudhakar V, Naidoo J, Samaranch L, et al. Infuse-as-you-go convective delivery to enhance coverage of elongated brain targets: technical note. J Neurosurg. 2019;1-8doi: 10.3171/2019.4.JNS19826.
Sudhakar, V., Naidoo, J., Samaranch, L., Bringas, J. R., Lonser, R. R., Fiandaca, M. S., & Bankiewicz, K. S. (2019). Infuse-as-you-go convective delivery to enhance coverage of elongated brain targets: technical note. Journal of neurosurgery, 1-8. https://doi.org/10.3171/2019.4.JNS19826
Sudhakar, Vivek, et al. "Infuse-as-you-go convective delivery to enhance coverage of elongated brain targets: technical note." Journal of neurosurgery vol. (2019): 1-8. doi: https://doi.org/10.3171/2019.4.JNS19826
Sudhakar V, Naidoo J, Samaranch L, Bringas JR, Lonser RR, Fiandaca MS, Bankiewicz KS. Infuse-as-you-go convective delivery to enhance coverage of elongated brain targets: technical note. J Neurosurg. 2019 Jul 12;1-8. doi: 10.3171/2019.4.JNS19826. Epub 2019 Jul 12. PMID: 31299656.
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J Neurosurg. 2019 Jul 12;1-8. doi: 10.3171/2019.4.JNS19826. Epub 2019 Jul 12.

Infuse-as-you-go convective delivery to enhance coverage of elongated brain targets: technical note.

Journal of neurosurgery

Vivek Sudhakar, Jerusha Naidoo, Lluis Samaranch, John R Bringas, Russell R Lonser, Massimo S Fiandaca, Krystof S Bankiewicz

Affiliations

  1. 1Department of Neurological Surgery, University of California, San Francisco, California; and.
  2. 2Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.

PMID: 31299656 DOI: 10.3171/2019.4.JNS19826

Abstract

OBJECTIVE: To develop and assess a convective delivery technique that enhances the effectiveness of drug delivery to nonspherical brain nuclei, the authors developed an occipital "infuse-as-you-go" approach to the putamen and compared it to the currently used transfrontal approach.

METHODS: Eleven nonhuman primates received a bilateral putamen injection of adeno-associated virus with 2 mM gadolinium-DTPA by real-time MR-guided convective perfusion via either a transfrontal (n = 5) or occipital infuse-as-you-go (n = 6) approach.

RESULTS: MRI provided contemporaneous assessment and monitoring of putaminal infusions for transfrontal (2 to 3 infusion deposits) and occipital infuse-as-you-go (stepwise infusions) putaminal approaches. The infuse-as-you-go technique was more efficient than the transfrontal approach (mean 35 ± 1.1 vs 88 ± 8.3 minutes [SEM; p < 0.001]). More effective perfusion of the postcommissural and total putamen was achieved with the infuse-as-you-go versus transfronatal approaches (100-µl infusion volumes; mean posterior commissural coverage 76.2% ± 5.0% vs 32.8% ± 2.9% [p < 0.001]; and mean total coverage 53.5% ± 3.0% vs 38.9% ± 2.3% [p < 0.01]).

CONCLUSIONS: The infuse-as-you-go approach, paralleling the longitudinal axis of the target structure, provides a more effective and efficient method for convective infusate coverage of elongated, irregularly shaped subcortical brain nuclei.

Keywords: AC-PC = anterior commissure–posterior commissure; CED = convection-enhanced delivery; MCP = midcommissural point; NHP = nonhuman primate; PD = Parkinson’s disease; Parkinson’s disease; convection-enhanced delivery; gene therapy; infusion; putamen; surgical technique

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