Name of the Procedure:

Chemotherapy Injection, Subarachnoid or Intraventricular via Subcutaneous Reservoir, Single or Multiple Agents

Summary

This procedure involves injecting chemotherapy drugs directly into the cerebrospinal fluid (CSF) via a small, surgically implanted reservoir under the skin. The aim is to treat cancers affecting the brain or spinal cord by delivering medication directly to the site where it's needed most.

Purpose

This procedure targets cancers that are within or around the brain and spinal cord. By delivering the chemotherapy directly into the CSF, it ensures the medication reaches areas that other delivery methods can't easily penetrate. The goal is to effectively treat the cancer while reducing systemic side effects.

Indications

• Brain tumors
• Central nervous system (CNS) lymphomas
• Leukemia with CNS involvement Patients might be selected based on factors like the type and stage of cancer, previous treatment responses, and overall health.

Preparation

• Patients might need to fast for several hours before the procedure.
• Blood tests and imaging studies (like MRI or CT scans) may be required to assess the treatment area.
• Medication adjustments could be necessary, particularly if the patient is on blood thinners or other relevant drugs.

Procedure Description

1. The patient is positioned comfortably, and the skin over the reservoir is sterilized.
2. A needle is carefully inserted into the subcutaneous reservoir.
3. Chemotherapy drugs are slowly injected into the reservoir, allowing them to flow into the subarachnoid or intraventricular spaces.
4. The needle is removed, and the injection site is monitored for any immediate reactions or complications.

Tools include the subcutaneous reservoir, sterile needles, and chemotherapy agents. Depending on the patient's comfort and the specific protocol, local anesthesia or sedation might be used.

Duration

The procedure typically takes about 30 minutes to an hour.

Setting

It is usually performed in a hospital, outpatient clinic, or specialized treatment center with appropriate facilities.

Personnel

• Oncologist or specialist physician
• Nurse or medical assistant
• Anesthesiologist (if sedation is used)

Risks and Complications

• Infection at the injection site or in the CNS
• Bleeding
• Headache or nausea
• Neurological symptoms such as dizziness or weakness
• Allergic reactions to the chemotherapy agents

Benefits

The localized delivery of chemotherapy can be more effective for CNS cancers and may reduce systemic side effects. Benefits can often be observed within weeks to months, depending on the treatment plan.

Recovery

• Patients are generally observed for a short period post-procedure.
• Instructions include monitoring for signs of infection or complications and managing symptoms like headache or nausea.
• Recovery times can vary, but many patients can resume normal activities within a day or two.
• Follow-up appointments are essential to monitor the efficacy of treatment and manage any side effects.

Alternatives

• Systemic chemotherapy
• Radiation therapy
• Surgical interventions Each alternative has its own set of pros and cons, such as varying effectiveness, side effects, and impact on quality of life.

Patient Experience

Patients may feel pressure or mild discomfort during the needle insertion. Post-procedure, mild side effects like headache or nausea can occur but are usually manageable with medications. Comfort measures include resting, hydration, and over-the-counter pain relief options as needed.