Image-guided convection-enhanced drug delivery

Direct perfusion of specific regions of the central nervous system (CNS) by convection-enhanced delivery (CED) is rapidly becoming more widely used for the delivery of compounds in the research and treatment of various neural disorders. Two patients with progressive intrinsic brainstern pathology (Type 2 Gaucher disease and diffuse pontine glioma) were treated by CED of putative therapeutic agents mixed with gadolinium-DTPA. Using intraoperative MR-scanning, real-time imaging during infusion clearly demonstrated progressive filling of the targeted region with drug and gadolinium-DTPA infusate. Neither patient had clinical or imaging evidence of short- or long-term toxicity. CED may be used to safely perfuse targeted diseased regions of the CNS, including the brainstem, with therapeutic agents. Co-infused imaging surrogate tracers can be used to monitor and control the distribution of therapeutic agents in vivo. Patients with a variety of intrinsic brainstern and other CNS disorders may benefit from a similar treatment paradigm.