PDF(Pubmed)
Abstract：
Gliadel wafer implants (Eisai Inc., Woodcliff Lake, NJ, USA) have shown their efficacy in prolonging survival in patients with malignant gliomas. The safety of Gliadel wafers has also been reported; however, there is a certain risk of adverse events. We present a rare case of refractory cerebrospinal fluid (CSF) leakage with eosinophilic meningitis in a patient with glioblastoma who underwent tumor resection with Gliadel wafer implants. A 60-year-old man presented with a glioblastoma in the right temporal lobe. The patient underwent tumor resection with Gliadel wafer implants. During the postoperative course, the patient presented with intractable CSF leakage and the development of a pseudomeningocele. A delayed rise in blood and CSF eosinophil count (a few weeks after the primary operation) and positive drug-induced lymphocyte stimulation test (DLST) results against the Gliadel wafer led to the diagnosis of an allergic reaction to these implants. Removal of the Gliadel wafers resolved the eosinophilic reaction; however, the patient subsequently required a shunt procedure for persistent hydrocephalus. This case highlights the importance of investigating rare causes of refractory CSF leakage and hydrocephalus due to allergic reactions to Gliadel wafers. Delayed elevations of eosinophils in blood and CSF tests may lead to a diagnosis of eosinophilic meningitis. DLST against Gliadel wafers is also useful for diagnosis when it is available. To control the hydrocephalus, not only the shunt procedure but also wafer removal must be considered; however, patients with limited life expectancy are generally hesitant to undergo such additional procedures.
摘要：
Gliadel晶圆植入物(EisaiInc.，伍德克利夫湖,NJ,美国）已显示出它们在延长恶性神经胶质瘤患者生存期方面的功效。Gliadel晶圆的安全性也有报道；然而，有一定的不良事件风险。我们介绍了一例罕见的难治性脑脊液（CSF）泄漏伴嗜酸性粒细胞性脑膜炎的胶质母细胞瘤患者，该患者接受了Gliadel晶圆植入物的肿瘤切除术。一名60岁的男子在右颞叶出现胶质母细胞瘤。患者接受了Gliadel晶圆植入物的肿瘤切除术。在术后过程中，患者出现顽固性脑脊液漏和假性脑膜膨出。血液和CSF嗜酸性粒细胞计数的延迟上升（初次手术后几周）以及针对Gliadel晶片的药物诱导淋巴细胞刺激测试（DLST）阳性结果导致对这些植入物的过敏反应的诊断。去除Gliadel晶片解决了嗜酸性粒细胞反应；然而，患者随后因持续性脑积水需要进行分流手术.此病例强调了调查由于对Gliadel晶片的过敏反应而引起的难治性CSF泄漏和脑积水的罕见原因的重要性。血液和CSF检查中嗜酸性粒细胞的延迟升高可能导致嗜酸性粒细胞性脑膜炎的诊断。当可用时,针对Gliadel晶片的DLST对于诊断也是有用的。为了控制脑积水，不仅要考虑分流程序，还要考虑晶圆的移除；然而，预期寿命有限的患者通常不愿接受此类额外手术.
