Intraventricular Transplantation of Autologous Bone Marrow Mesenchymal Stem Cells via Ommaya Reservoir in Persistent Vegetative State Patients after Haemorrhagic Stroke: Report of Two Cases & Review of the Literature

Abstract

Background: One of the most devastating diseases, stroke, is a leading cause of death and disability worldwide with severe emotional and economic consequences. The purpose of this article is mainly to report the effect of intraventricular transplantation via an Ommaya reservoir using autologous bone marrow mesenchymal stem cells (BM-MSCs) in haemorrhagic stroke patients. Case Presentations: Two patients, aged 51 and 52, bearing sequels of haemorrhagic stroke were managed by intraventricular transplantation of BM-MSCs obtained from their own bone marrow. Before the procedure, both patients were bedridden, tracheostomised, on nasogastric (NG) tube feeding and in hemiparesis. The cells were transplanted intraventricularly (20 x 10 6 cells/2.5 ml) using an Ommaya reservoir, and then repeated transplantations were done after 1 and 2 months consecutively. The safety and efficacy of the procedures were evaluated 3, 6 and 12 months after treatment. The National Institute of Health Stroke Scale (NIHSS) was used to evaluate the patients' neurological status before and after treatment. No adverse events derived from the procedures or transplants were observed in the one-year follow-up period, and the neurological status of both patients improved after treatment. Conclusions: Our report demonstrates that the intraventricular transplantation of BM-MSCs via an Ommaya reservoir is safe and it improves the neurological status of post-haemorrhagic stroke patients. The repeated transplantation procedure is easier and safer to perform via a subcutaneously implanted Ommaya reservoir.

Mesenchymal Stem Cells Transplantation in Intracerebral Hemorrhage: Application and Challenges

“…Mesenchymal stem cells have been extensively studied and confirmed as an effective treatment strategy for animal cerebral hemorrhage models, however, less research has been investigated in human cerebral hemorrhage. The first application of MSCs in humans was a case report about two persistent vegetative state patients of hemorrhagic stroke, and then they were followed-up with for a 1 year period ( Al Fauzi et al, 2016 ). Patients were intraventricularly injected with MSCs (20 × 10 6 cells/2.5 mL) three times at intervals of 1 month using an Ommaya reservoir.…”

Application of stem cells and exosomes in the treatment of intracerebral hemorrhage: an update

“…According to a case report published in 2016, researchers injected autologous BMSCs into the ventricles of two patients who were in a minimally conscious state after cerebral hemorrhage. After 12 months, the National Institutes of Health Stroke Scale scores of both patients had improved [ 183 ]. In a double-blind, phase I/II randomized controlled trial, autologous BM-MSCs were injected intravenously into patients with ICH.…”