Parenchymal damage in the territory of the anterior choroidal artery following supraophthalmic intracarotid administration of CDDP for treatment of malignant gliomas.

We treated ten patients with malignant glioma by intracarotid chemotherapy with cis-diamminedichloroplatinum (CDDP) and/or 3-(4-amino-2-methyl-5-pyrimidinyl)methyl-1-(2-chloroethyl)-3-nitrosourea (ACNU). Three of the patients who underwent supraophthalmic intracarotid infusion of CDDP developed a low-density area in the basal ganglia on CT scan or an enhancing lesion in the hypothalamic region on MRI, with or without neurologic symptoms. No patient had such complications with supraophthalmic infusions of ACNU, or with cervical intracarotid infusion of CDDP or selective infusion of CDDP via the anterior or middle cerebral arteries. Supraophthalmic intracarotid administration of CDDP may augment drug delivery to tumors and prevent visual complications, but is accompanied by considerable risk of parenchymal damage in the territory of the anterior choroidal artery. Possible mechanisms for such complications are discussed.