Optic nerve degeneration caused by supraophthalmic carotid artery infusion with cisplatin and ACNU

Abstract

A 28-year-old woman with a left frontoparietal anaplastic astrocytoma was treated postoperatively with a combination of cisplatin and 1-(4-amino-2-methylpyrimidine-5-yl) methyl-3-(2-chloroethyl)-3-nitrosourea hydrochloride (ACNU). The drugs were infused via the left supraophthalmic internal carotid artery in an attempt to avoid ocular toxicity. The patient subsequently developed blindness in the left eye and a right temporal hemianopsia from marked degeneration of the left optic nerve and tract. It is apparent that the placement of a catheter into the supraophthalmic carotid artery does not exclude visual complications.

Preventive effects of interleukin 1 ? for ACNU-induced myelosuppression in malignant brain tumors: the experimental and preliminary clinical studies

“…The intra-arterial infusion of chemotherapeutic agents reduces the systemic toxicity of the drugs, but ocular toxicity may occur. Placing a catheter into the distal part of the carotid artery from the origin of the ophthalmic artery does not prevent visual complications [29]. Extremely high doses of ACNU alone can lead to other complications: pulmonary and hepatic toxicity or complications due to neurotoxicity of the drugs that cross the blood-brainbarrier, damaging normal neural tissues [27].…”

Oculoand Retinotoxicity of Antitumor Drugs Based on Alkylating Agents

“…Больному с астроцитомой вводили комбинацию цисплатина с нимустином инфузией в левую сонную артерию. В результате у больного наблюдалась гемианопсия, ассоциированная с дегенерацией левого зрительного нерва [59]. В работе K. Sato et al ( 2005) на голых беcтимусных мышах с привитыми ксенографтами (MGMT+) и (MGMT-) линий клеток карциномы желчного пузыря человека показали, что чувствительность клеточных ксенографтов к ACNU зависит от их MGMT-статуса [57].…”

Neurological complications of chemotherapy to the peripheral nervous system

“…Cranial nerve impairment was observed in patients who received intra-arterial cisplatin (Pomes et al, 1986), and intracarotid administration of cisplatin for CNS tumors may lead to serious optic toxicity (Shimamura et al, 1990;Maiese et al, 1992). Lumbosacral plexopathies were observed after intra-arterial cisplatin administration in the external or internal iliac arteries (Castellanos et al, 1987).…”