Supraophthalmic carotid infusion for brain chemotherapy. Experience with a new single-lumen catheter and maneuverable tip.

A single-lumen catheter with a maneuverable tip which does not incorporate a balloon has been developed for supraophthalmic intracarotid infusion of chemotherapeutic agents for central nervous system neoplasms. Supraophthalmic carotid catheterization was accomplished in 48 (96%) of the first 50 consecutive infusions in which this catheter was used. None of the 31 patients who underwent this procedure developed optic neuropathy or loss of vision. Ten patients developed Marcus-Gunn pupils, ipsilateral to the infused carotid artery in two and contralateral to the infused carotid artery in eight. Thrombosis of the carotid artery occurred after infusion in one patient. Problems associated with the technique include a tendency for the catheter to retract proximally during infusion in some patients, and the necessity for surgical exposure of the carotid artery. The infusion technique protects the eye from the high-concentration first-pass of chemotherapeutic agents administered via the carotid artery. Since the tip of this catheter can be hydraulically guided, it may prove to be useful in other areas of transarterial neurosurgical procedures.