Certas programmable shunt valves with a "virtual off" for intrathecal chemotherapy delivery in infants with high-grade CNS tumors and hydrocephalus

Abstract Introduction Current chemotherapy protocols for treatment of embryonal brain tumors in infants may recommend administration of intrathecal chemotherapy, either by a lumbar tap or via an Ommaya reservoir. Children with concurrent hydrocephalus and shunts may have subtherapeutic levels of chemotherapy in the CSF due to constant CSF drainage to extra-CNS compartments. We present our experience in delivery of chemotherapy to young children via programmable valves. Results A retrospective analysis of infants with CNS malignancies together with hydrocephalus treated with a shunt and a programmable valve (CERTAS™ Plus Programmable Valves - Integra Life Sciences) was conducted. Five infants 1.1-3 years of age (mean age 2 years) were included. Pathologies included two atypical rhabdoid teratoid tumors, two medulloblastomas, and one metastatic rhabdomyosarcoma. Intrathecal injections were conducted in an outpatient setting unless hospitalization was required for other reasons. 4 children did not require sedation, one child was noncompliant and required sedation. 67 chemotherapeutic administrations were performed directly through the valve while set on a high opening pressure (setting 8) for several hours (35 hydrocortisone + cytarabine, 32 topotecan). There were no infections, leaks, or major complications. One child required a wound revision due to exposure of the proximal catheter related to extremely thin skin. One patient experienced a “stuck” setting of the valve. Conclusions Programmable ventriculoperitoneal valves are a safe method for delivery of chemotherapy in infants. This technique may potentially have an added value for children with concurrent shunts, and may also obviate the need for an additional ventricular access device (such as an Ommaya reservoir).