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Yukitaka Ushio, Toru Hayakawa, and Heitaro Mogami

C hemotherapy is a promising treatment for patients with malignant glioma, although it has not yet been proved sufficiently effective. In this form of therapy an adequate uptake of the effective drug by the tumor is of fundamental importance. The present study was designed to investigate the uptake of a cytostatic agent by mouse glioma and to compare the intravenous and intrathecal administration of this drug. Materials and Methods Induction of Tumors Brain tumors were induced by the technique of Zimmerman and Arnold 32 in 5-week-old male mice of

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Nicholas C. Bambakidis, Mary Petrullis, Kui Xu, Brian Rothstein, Ioannis Karampelas, Youzhi Kuang, Warren R. Selman, Joseph C. LaManna, and Robert H. Miller

× 40. Discussion Role of Shh in Stroke In this study we observed a preservation of neural tissue and upregulation of neural progenitor cells in the SVZ compared with control animals. Along with this improvement, intrathecal administration of Shh results in behavioral improvement in a rodent model of MCA occlusion compared with control animals. Previous investigators have found the importance of the Shh pathway in animal models of ischemic injury, as well as the effects of stroke on endogenous neural progenitor cells populations in the SVZ. Zhang and

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František Remeš, Robert Tomáš, Vlastimil Jindrák, Václav Vaniš, and Michal Šetlík

/lumbar intrathecal antibiotics can lead to very quick CSF sterilization in postneurosurgical patients with meningitis and ventriculitis. The relapse rate of meningitis and/or ventriculitis is also very low among patients treated by IVT/IT antibiotics. Intraventricular/lumbar intrathecal administration of antibiotics appears to be an effective and safe treatment for infections of the CNS caused by multidrug-resistant organisms. In cases with signs of ventriculitis, we prefer the IVT route of antibiotics. In patients with meningitis, we did not show a lower efficacy of

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Nicholas C. Bambakidis

T o T he E ditor : Thank you for publishing our paper entitled “Improvement of neurological recovery and stimulation of neural progenitor cell proliferation by intrathecal administration of Sonic hedgehog. Laboratory investigation” ( J Neurosurg 116: 1114–1120, 2012). After our paper was published, we realized that the name of one of the authors had been printed inaccurately. Dr. Xu's name was incorrectly listed as “Xu Kui.” In correcting this error the authors' list now appears as follows: N icholas C. B ambakidis , M.D., 1 M ary P etrullis , B

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Diana Ko, Daniel Blatt, Chafic Karam, Kunal Gupta, and Ahmed M. Raslan

Nusinersen (Spinraza) is a US Food and Drug Administration–approved intrathecal medication for the treatment of spinal muscular atrophy (SMA). Adult patients with SMA often undergo thoracolumbar fusion to treat neurogenic scoliosis, preventing thecal access. The authors report a laminotomy technique and the ease of intrathecal access in three SMA patients with prior thoracolumbar fusions.

Patients were positioned in the lateral decubitus position or prone. Lumbar laminotomy was performed below the conus, between the lateral longitudinal rods, to preserve mechanical stability. Fluoroscopy provided real-time identification of instruments. Hardware was contoured with a carbide drill bit to develop the surgical window. Fiducial screws were placed along the perimeter for demarcation. Sublaminar wire removal caused dural defects that were repaired with a layer of dural substitute onlay and sealant. All patients successfully received nusinersen thecal injections via lumbar puncture by an interventional radiologist. Fluoroscopy time ranged from 6 to 36 seconds. No postoperative pseudomeningoceles, cerebrospinal fluid leaks, or wound complications occurred.

For patients with SMA and posterior fusion from prior scoliosis treatment, lumbar laminotomy is an effective method for creating thecal access for the administration of nusinersen.

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Ofer Sadan, Hannah Waddel, Reneé Moore, Chen Feng, Yajun Mei, David Pearce, Jacqueline Kraft, Cederic Pimentel, Subin Mathew, Feras Akbik, Pouya Ameli, Alexis Taylor, Lisa Danyluk, Kathleen S. Martin, Krista Garner, Jennifer Kolenda, Amit Pujari, William Asbury, Blessing N. R. Jaja, R. Loch Macdonald, C. Michael Cawley, Daniel L. Barrow, and Owen Samuels

days outcome . Neurocrit Care . 2012 ; 16 ( 3 ): 368 – 375 . 40 Suzuki M , Doi M , Otawara Y , Intrathecal administration of nicardipine hydrochloride to prevent vasospasm in patients with subarachnoid hemorrhage . Neurosurg Rev . 2001 ; 24 ( 4 ): 180 – 184 . 41 Stuart D , Christian R , Uschmann H , Palokas M . Effectiveness of intrathecal nicardipine on cerebral vasospasm in non-traumatic subarachnoid hemorrhage: a systematic review . JBI Database Syst Rev Implement Reports . 2018 ; 16 ( 10 ): 2013 – 2026 . 42 Hafeez S , Grandhi

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James W. Leiphart, Cynthia V. Dills, Ofer M. Zikel, Daniel L. Kim, and Robert M. Levy

T raditional clinical wisdom and limited human trials suggest that chronic neuropathic pain is relatively resistant to treatment with narcotic analgesics, which limits systemic opioid therapy as a therapeutic option. 1, 14 Recent clinical experience with the intrathecal administration of narcotic agents has demonstrated considerable efficacy for treatment of chronic nociceptive pain secondary to cancer. 2 These studies have not been widely extended to patients with chronic neuropathic pain, largely because of poor empirical results with parenteral or oral

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Robert E. Harbaugh, Dennis W. Coombs, Richard L. Saunders, Michael Gaylor, and Mark Pageau

depression than bolus injections, 15 and epidural infusion may be safer than intrathecal administration, 9, 23 although this remains unproven. The identification of opiates that produce analgesia but not respiratory depression 16 may substantially decrease the risk of intraspinal narcotic analgesia. In addition, a totally implantable system for intraspinal narcotic administration decreases the risk of infection. 15, 17 The cases presented here illustrate a number of these points. Neither patient experienced respiratory depression, sedation, pruritus, nausea, or

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Peter J. Zed, H. grant Stiver, Virginia Devonshire, Peter J. Jewesson, and Fawziah Marra

usually be corrected with a simple revision and without causing significant morbidity to the patient. However, complications such as a CSF leak, skin necrosis, overdose, and infection can result in significant rates of morbidity and mortality. Meningitis following intrathecal delivery of baclofen is a rare but serious complication that has been difficult to treat without removal of the intrathecal pump. 8 Success rates with intravenous antibiotic agents for the treatment of meningitis have been low; therefore, intrathecal administration of antibiotic drugs is often

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Jay M. Meythaler, Anne McCary, and Mark N. Hadley

without spasticity. Many patients have to learn to adapt mobility, transfer, and self-care techniques to the changes (reduction) in their spasticity. Patients typically require a period of intensive inpatient rehabilitation to benefit functionally from the decreased motor tone and/or increased voluntary motor control they experience with the intrathecal administration of baclofen. 1, 4 Dosage adjustments are made in small increments of 10 to 20% to achieve symptomatic improvement and can be performed as soon as 24 hours after the preceding dosage adjustment. The first