Pierre Gobin

Spontaneously Resolving Periocular Erythema and Ciliary Madarosis Following Intra-arterial Chemotherapy for Retinoblastoma.

Purpose and Design: To describe an unusual clinical finding seen in children undergoing intra-arterial chemotherapy for retinoblastoma. Materials and Methods: A retrospective review of 69 eyes of 63 patients receiving intra-arterial chemotherapy over a 3-year period. Charts and photographs of 69 consecutive cases were reviewed, and data were collected on patients with clinical evidence of a hyperemic cutaneous periocular abnormality following the procedure. Results: A blanching erythematous and edematous patch was noted in the periocular region in 16% (11 of 69) of the children who received intraarterial chemotherapy. The plaque extended into the region of the supertrochlear and medial marginal artery distribution on the ipsilateral side of the intra-arterial chemotherapy. All patches of erythema spontaneously resolved within 3 months following completion of the intra-arterial chemotherapy. Conclusion: Periocular erythema and swelling is a self-limited clinical finding associated with intra-arterial chemotherapy in a small number of patients.

Endovascular surgery for vascular malformations of the spinal cord

Abstract Since the introduction of modern selective spinal arteriography, catheter-based endovascular surgery has evolved as an important modality for the management of spinal vascular malformations. The endovascular therapy functions either as an adjunct to open surgery or as the primary treatment of choice. This article reviews the current status of endovascular surgery for spinal cord vascular malformations with particular emphasis on its technical aspects.

014 Intra-arterial chemotherapy (chemosurgery) in the ophthalmic artery for the treatment of retinoblastoma in children: 3 year experience

Introduction: Retinoblastoma is the first cause of eye cancer in children. Conventional treatment includes local treatment with laser, cryotherapy or radioactive plaque, and if these fail, external beam radiotherapy and intravenous chemotherapy are used. However, the diagnosis is often made late, and enucleation is frequent. Materials and Methods: In May 2006 we started an IRB approved protocol to perform intra-arterial chemotherapy (chemosurgery) in children with advanced retinoblastoma who were candidates for enucleation. Children had an initial ophthalmologic examination under anesthesia (EUA) to confirm the diagnosis and the extent of the disease. EUA allowed …

Intraarterial chemotherapy for kissing macula tumors in retinoblastoma.

PURPOSE To describe the management of kissing macula retinoblastoma tumors treated with intraarterial chemotherapy. METHODS Superselective infusion of chemotherapy (combinations of melphalan, topotecan, and carboplatin) into the ophthalmic artery of children with retinoblastoma who had kissing macula tumors was administered on an outpatient basis. Results were assessed with indirect ophthalmoscopy, RetCam digital photography, B-scan ultrasonography, and electroretinograms. Three children with bilateral retinoblastoma (aged 6.1, 7, and 16 months) and kissing macula tumors in an eye were treated. RESULTS All children are alive without the need for removal of the eye, systemic chemotherapy, or external beam irradiation. In each case, the kissing tumors retracted, leaving an anatomically normal fovea. Final 30-Hz flicker electroretinograms were 93.9, 65, and 63.9 μV (under anesthesia). There were no significant systemic toxicities. CONCLUSION Superselective infusion of chemotherapy by means of the ophthalmic artery of young children with kissing macula tumors resulted in prompt shrinkage of tumors away from the fovea. There were no systemic side effects.

E-026 Thromboembolic complications in endovascular treatment of middle cerebral artery aneurysms

Introduction/Purpose Occlusion rates and morbidity associated with endovascular treatment of middle cerebral artery (MCA) aneurysms is widely varied in the literature. Complete or near-complete occlusion rates range from 53.5%–84.2%, and perioperative morbidity ranges from 6.0%–19.6%, with thromboembolic complications representing the majority. Some authors have argued against the use of assist devices such as balloons or stents, suggesting that they increase the risk of thromboembolic complications. We present our single center experience of endovascular treatment for MCA aneurysms, with a focus on thromboembolic complications. Materials and Methods The cases of 92 MCA aneurysms that were treated with endovascular intervention between 2003–2015 were retrospectively reviewed. Mycotic and giant aneurysms treated with parent vessel occlusion were excluded, leaving 78 cases. Demographic, clinical, and radiographic variables were recorded and analyzed. Results 36 (46%) were ruptured, 59 (75%) were MCA bifurcation, 9 (11%) were anterior temporal, 7 (9%) were M1, and 4 (5%) were M2. Average size was 5.9 mm with an average neck size of 3.2 mm, and an average dome/neck ratio of 1.9. 52 (67%) of the aneurysms had a vessel arising from the neck. 32 (41%) of cases utilized an assist device (23 (29%) balloon, 9 (12%) stent). Complete or near-complete occlusion (Raymond 1 or 2) was achieved in 68 (87%), and only partial occlusion in 10 (13%). 53 (68%) of cases had follow up of at least 6 months. Of these, 36 (68%) had complete occlusion (Raymond 1), while 16 (30%) had residual or recurrent neck and 1 (2%) had residual dome filling (Raymond 2 and 3, respectively). 6 (11%) of these required retreatment while the other 11 (21%) were managed conservatively with serial imaging demonstrating stable residual neck. 43 (90%) of patients with available follow up records had good functional outcome (MRS 0–2). There were 15 (19%) thromboembolic events, 1 intraoperative rupture requiring craniotomy, 1 iatrogenic arterial dissection, and 2 instances of coil migration. Of the thromboembolic events, 12 (15%) resolved with intervention, 2 (3%) were delayed requiring take back which then resolved, and only 1 (1%) could not be resolved which resulted in permanent neurologic deficit. 13 (17%) utilized intra-arterial thrombolysis and 2 (3%) mechanical thrombectomy. Thus, while there was an overall 19% thromboembolic event rate, only 1% resulted in permanent thrombotic occlusion or neurologic deficit. The use of an assist device, bifurcation aneurysm, and the presence of a vessel arising from the neck of the aneurysm trended toward higher risk of transient thromboembolic event, although this did not reach statistical significance. However, no cases utilizing an assist device resulted in permanent neurologic deficit. Conclusion In the endovascular treatment of MCA aneurysms, the use of balloons or stents and aneurysm complexity such as bifurcation origin or vessel arising from the neck can carry a high risk of thromboembolic complication. If surgeons are aware of this risk, utilize delayed angiograms at the end of the case to ensure that no thrombus has formed, and have thrombolytic drugs or mechanical thrombectomy devices readily available, permanent complications can be safely avoided. Disclosures T. Link: None. S. Boddu: None. N. Lin: None. P. Gobin: None. J. Knopman: None. A. Patsalides: None.

Second primary malignancies in retinoblastoma patients treated with intra-arterial chemotherapy: the first 10 years

Background/Aims Survivors of retinoblastoma carry a lifetime risk of secondary malignancies. It is well established that external beam radiation increases this risk; however, the risk with ophthalmic artery chemosurgery (OAC) remains unknown. We report on 10 years of experience with OAC and the rate of second primary malignancy (SPM) development. Methods This is a single-centre retrospective review approved by the Memorial Sloan Kettering Cancer Center Institutional Review Board of all patients who received OAC over a 10-year period, from May 2006 to November 2016. The second tumour incidence and survival in patients with germline disease (bilateral and unilateral with family history or confirmed germline mutation) was estimated using the Kaplan-Meier method. Patients who received external beam radiotherapy were excluded from analyses. Results Two hundred and thirty-three patients with heritable retinoblastoma who received OAC were analysed. Nineteen patients were excluded for having received external beam radiation. The Kaplan-Meier estimate of the likelihood for SPM development was 2.7% at 5 years (95% CI 0 to 25). All of the SPMs were pineoblastomas and all patients had bilateral disease in this cohort. Conclusions In our 10-year experience, we have found that SPM development in patients with germline retinoblastoma treated with OAC alone is comparable to previously published rates. In the first 10 years, OAC did not increase the known incidence of SPMs. This cohort will continue to be followed to establish the rate of development with extended follow-up.