Tuesday, August 11, 2009
Intracerebroventricular Administration of Drugs

Reference: Cook AM, et al. Pharmacotherapy 2009;29(7):832

Guidelines do not currently exist for drug administration via the intracerebroventricular route, however, a good review was just published in Pharmacotherapy.

Methods of administration include:

· Directly into the lumbar cistern (thecal sac), Intrathecally

o Low risk and easily performed at bedside, however, requires separate puncture for subsequent doses which increases risk of infection

· Directly into the lateral ventricle

o Repeated taps not routinely performed due to risk of neurovascular injury or intracranial hemorrhage

· Permanent access through implanted catheter connected to reservoir

o e.g. Ommaya reservoir

· Ventriculostomy

o Ideal for situations requiring limited time for CSF drainage or intraventricular drug administration. Should use caution and close monitoring of intracranial pressure


Considerations for drug administration:

· Volume of solution

o Affects the distribution or clearance of drug. Increasing volume would result in an alteration in the normal intracranial components to maintain normal intracranial pressure.

· Rate of instillation

o Slow instillation recommended to allow for extracellular fluid displacement to prevent tissue damage. Recommend small volumes <3ml>