Continuous Intrathecal Medication Delivery With the IRRA flow Catheter: Pearls and Early Experience

Area of Science:

• Neurosurgery
• Pharmacology
• Medical Devices

Background:

• Intrathecal (IT) medications are typically administered via intraventricular or subarachnoid catheterization.
• Direct ventricular delivery has been achieved sporadically via external ventricular drains (EVDs) or Ommaya reservoirs.
• EVD delivery presents challenges such as breaching sterility, bolus administration, and system clamping.

Purpose of the Study:

• To present treatment protocols and techniques for a novel active fluid exchange device for direct intraventricular medication delivery.
• To evaluate the safety and efficacy of this new system in treating severe cerebral ventricular conditions.

Main Methods:

• Utilized a newly developed active fluid exchange device for direct intraventricular therapy.
• Developed and applied specific treatment protocols and technical guidance for the device.

Main Results:

• Seventy patients with conditions like subarachnoid hemorrhage, intraventricular hemorrhage, ventriculitis, and cerebral abscess were treated.
• The overall complication rate was 14%, with only one catheter occlusion.
• Low rates of hemorrhage, infection, and cerebrospinal fluid leak were observed.

Conclusions:

• Current continuous IT medication protocols are based on intermittent bolus studies, necessitating further research into continuous dosing pharmacokinetics and safety.
• The new device enables continuous, sterile IT medication delivery, potentially expanding pharmacotherapeutic options.
• This report provides a guide for the safe and effective use of the IRRA flow active fluid exchange catheter for IT medication delivery.