ABSTRACT
We have developed a piglet model to assess chemotherapy administration directly into the fourth ventricle as a potential treatment for medulloblastoma and other malignant posterior fossa tumors. The objective of this study was to assess safety and pharmacokinetics after methotrexate infusions into the fourth ventricle. Catheters were inserted into the fourth ventricle and lumbar cistern in five piglets. Two milligrams of Methotrexate (MTX) was infused into the fourth ventricle on five consecutive days. Safety was assessed by neurological examination, 4.7 T MRI, and post-mortem pathological analysis. MTX levels in serum and cerebrospinal fluid (CSF) were measured, and area under the concentration-time curve (AUC) was calculated for CSF samples. No neurological deficits were caused by MTX infusions. One piglet died from complications of anesthesia induction for MRI scanning. MRI scans showed accurate catheter placement without signal changes in the brainstem or cerebellum. One piglet had asymptomatic ventriculomegaly. Pathological analysis demonstrated meningitis and choroid plexitis consisting predominantly of CD-3 positive T-lymphocytes in all piglets and a small focal area of subependymal necrosis in one. In all piglets, mean peak MTX level in fourth ventricular CSF exceeded that in lumbar CSF by greater than five-fold. Serum MTX levels were undetectable or negligible. Statistically significant differences between fourth ventricle and lumbar AUC were detected at peaks (P = 0.01) and at all collection time points (P = 0.01) but not at troughs (P = 0.36). MTX can be infused into the fourth ventricle without clinical or radiographic evidence of damage. An inflammatory response without clinical correlate is observed. Significantly higher peak MTX levels are observed in the fourth ventricle than in the lumbar cistern.
Subject(s)
Enzyme Inhibitors/administration & dosage , Enzyme Inhibitors/pharmacokinetics , Fourth Ventricle/drug effects , Methotrexate/administration & dosage , Methotrexate/pharmacokinetics , Animals , Area Under Curve , Cell Count/methods , Enzyme Inhibitors/blood , Enzyme Inhibitors/cerebrospinal fluid , Magnetic Resonance Imaging/methods , Methotrexate/blood , Methotrexate/cerebrospinal fluid , Models, Animal , Swine , Time FactorsABSTRACT
OBJECTIVE/HYPOTHESIS: Loss of auditory function after cochlear implant (CI) electrode insertion occurs in two stages in the laboratory rat. An immediate loss is followed by a progressive loss over 7 days. Similar stages of acute and progressive neuronal loss occur after trauma in the central nervous system where hypothermia has been shown to have a protective effect. We hypothesize that hypothermia has a similar protective effect against loss of auditory function caused by CI electrode insertion trauma. METHODS: Thirty rats underwent surgery in one cochlea; the contralateral ear was an unoperated control. In the normothermia group, CI electrode insertion trauma was generated with rectal temperature maintained at 37 degrees C throughout the experiment. In the mild hypothermia group, electrode trauma was generated with rectal temperature lowered to 34 degrees C. In the surgical control group, mock surgery was performed at 37 degrees C. Multiple frequency auditory brainstem response (ABR) and distortion product otoacoustic emission (DPOAE) testing of all ears was performed before surgery, immediately afterward, and on postoperative days 3, 5, and 7. RESULTS: Both ABR and DPOAE testing demonstrated partial loss of auditory function after electrode insertion trauma. However, the hypothermia group had significantly less functional loss in the immediate stage and no significant loss in the progressive stage. CONCLUSION: Mild hypothermia protects auditory function during CI electrode insertion.
