Open AccessIntratumoral Arteriovenous Shunting in Malignant Gliomas
Author(s) -
Luigi Mariani,
Gerhard Schroth,
J. P. Wielepp,
Andreas Haldemann,
Rolf W. Seiler
Publication year - 2001
Publication title -
neurosurgery/neurosurgery online
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.485
H-Index - 34
eISSN - 1081-1281
pISSN - 0148-396X
DOI - 10.1097/00006123-200102000-00022
Subject(s) - medicine , shunting , shunt (medical) , glioma , radiology , pathology , scintigraphy , nuclear medicine , cancer research
OBJECTIVE Intratumoral arteriovenous shunting in glioblastomas has been suspected but neither proven nor quantified. METHODS Using a previously described technique of selective intra-arterial intratumoral injection of 99mTc-labeled microparticles (macroaggregated albumin), we measured the amount of radioactivity, by cerebral and pulmonary scintigraphy, in seven patients with malignant gliomas (six with glioblastomas and one with an anaplastic oligodendroglioma). The pulmonary shunt index was calculated as a percentage from the pulmonary/pulmonary plus cerebral radioactivity ratio. RESULTS The results revealed a mean pulmonary shunt index of 67% (range, 47–89%), indicating that most of the microparticles injected into the tumor via the arterial route bypassed the tumor and reached the lungs. The measured arteriovenous shunting was greater when the injection was performed in an artery exclusively perfusing the tumor. CONCLUSION Important intratumoral arteriovenous shunting exists in glioblastomas. The potential consequences of this finding for intra-arterial treatment strategies are discussed.