Best practices for the use of intracerebroventricular drug delivery devices

Irene Slavc; Jessica L Cohen-Pfeffer; Sridharan Gururangan; Jeanne Krauser; Daniel A Lim; Marcos Maldaun; Christoph Schwering; Adam J Shaywitz; Manfred Westphal

doi:10.1016/j.ymgme.2018.05.003

Best practices for the use of intracerebroventricular drug delivery devices

Mol Genet Metab. 2018 Jul;124(3):184-188. doi: 10.1016/j.ymgme.2018.05.003. Epub 2018 May 16.

Authors

Irene Slavc¹, Jessica L Cohen-Pfeffer², Sridharan Gururangan³, Jeanne Krauser³, Daniel A Lim⁴, Marcos Maldaun⁵, Christoph Schwering⁶, Adam J Shaywitz², Manfred Westphal⁶

Affiliations

¹ Medical University of Vienna, Department of Pediatrics and Adolescent Medicine, Vienna, Austria. Electronic address: irene.slavc@meduniwien.ac.at.
² BioMarin Pharmaceutical Inc., Novato, CA, USA.
³ McKnight Brain Institute, University of Florida, Gainsville, FL, USA.
⁴ University of California, San Francisco, CA, USA.
⁵ IEP-Hospital Sírio-Libanês, São Paulo, Brazil.
⁶ University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

PMID: 29793829
DOI: 10.1016/j.ymgme.2018.05.003

Abstract

For decades, intracerebroventricular (ICV), or intraventricular, devices have been used in the treatment of a broad range of pediatric and adult central nervous system (CNS) disorders. Due to the limited permeability of the blood brain barrier, diseases with CNS involvement may require direct administration of drugs into the brain to achieve full therapeutic effect. A recent comprehensive literature review on the clinical use and complications of ICV drug delivery revealed that device-associated complication rates are variable, and may be as high as 33% for non-infectious complications and 27% for infectious complications. The variability in reported safety outcomes may be driven by a lack of consensus on best practices of device use. Numerous studies have demonstrated that employing strict aseptic techniques and following stringent protocols can dramatically reduce complications. Key practices to be considered in facilitating the safe, long-term use of these devices are presented.

Keywords: Consensus; Drug delivery; ICV; Intracerebroventricular; Intrathecal; Ommaya reservoir; Rickham reservoir.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Central Nervous System Agents / administration & dosage*
Central Nervous System Diseases / drug therapy*
Drug Delivery Systems*
Humans
Injections, Intraventricular / instrumentation*
Practice Guidelines as Topic / standards*

Substances

Central Nervous System Agents