Fadi Al Saiegh1, Nohra Chalouhi2, Ahmad Sweid3, Jacob Mazza4, Nikolaos Mouchtouris5, Omaditya Khanna6, Stavropoula Tjoumakaris7, Reid Gooch8, Carol L Shields9, Robert Rosenwasser10, Pascal Jabbour11. 1. Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, USA. Electronic address: fadi.al-saiegh@jefferson.edu. 2. Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, USA. Electronic address: nohra.chalouhi@jefferson.edu. 3. Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, USA. Electronic address: ahmad.sweid@jefferson.edu. 4. Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, USA. Electronic address: Jacob.mazza@jefferson.edu. 5. Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, USA. Electronic address: nikolaos.mouchtouris@jefferson.edu. 6. Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, USA. Electronic address: omaditya.khanna@jefferson.edu. 7. Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, USA. Electronic address: stavropoula.tjoumakaris@jefferson.edu. 8. Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, USA. Electronic address: Reid.gooch@jefferson.edu. 9. Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA. Electronic address: carolshields@gmail.com. 10. Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, USA. Electronic address: robert.rosenwasser@jefferson.edu. 11. Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, USA. Electronic address: pascal.jabbour@jefferson.edu.
Abstract
OBJECTIVES: Intra-arterial chemotherapy (IAC) has become one of the most important pillars in retinoblastoma (Rb) management. It allows for targeted delivery of chemotherapy by superselective catheterization of the ophthalmic artery, thus, reducing systemic toxicity. As in most neurovascular procedures, IAC has traditionally been performed through a transfemoral access. However, recent publications have spurred the use of the transradial route for neuroendovascular procedures due to its lower complication rates and higher patient satisfaction. Here, we present the first case series in the literature on the technique, safety, and feasibility of IAC via the transradial route in the pediatric population. PATIENTS AND METHODS: We retrospectively analyzed our prospectively maintained database and present our technique and initial experience from 5 consecutive pediatric patients aged between 3 and 15 years who underwent 10 transradial IAC treatments. RESULTS: All IACs were performed successfully. Two patients had repeat IACs through the same wrist. There were no thromboembolic events or access site complications, such as hand ischemia or hematoma. All patients were discharged home the same day of the procedure. CONCLUSION: Our case series demonstrates the safety and feasibility of transradial IAC in pediatric patients with Rb. As more experience is gained with the transradial route for neurovascular procedures in adults, it may become the preferred route in some pediatric patients as well.
OBJECTIVES: Intra-arterial chemotherapy (IAC) has become one of the most important pillars in retinoblastoma (Rb) management. It allows for targeted delivery of chemotherapy by superselective catheterization of the ophthalmic artery, thus, reducing systemic toxicity. As in most neurovascular procedures, IAC has traditionally been performed through a transfemoral access. However, recent publications have spurred the use of the transradial route for neuroendovascular procedures due to its lower complication rates and higher patient satisfaction. Here, we present the first case series in the literature on the technique, safety, and feasibility of IAC via the transradial route in the pediatric population. PATIENTS AND METHODS: We retrospectively analyzed our prospectively maintained database and present our technique and initial experience from 5 consecutive pediatric patients aged between 3 and 15 years who underwent 10 transradial IAC treatments. RESULTS: All IACs were performed successfully. Two patients had repeat IACs through the same wrist. There were no thromboembolic events or access site complications, such as hand ischemia or hematoma. All patients were discharged home the same day of the procedure. CONCLUSION: Our case series demonstrates the safety and feasibility of transradial IAC in pediatric patients with Rb. As more experience is gained with the transradial route for neurovascular procedures in adults, it may become the preferred route in some pediatric patients as well.