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Short-term clinico-radiographic response to super-selective intra-arterial cerebral infusion of Bevacizumab for the treatment of vestibular schwannomas in Neurofibromatosis type 2.

Abstract
Neurofibromatosis type 2 (NF2) is an autosomal dominant syndrome with a prevalence of approximately 1 in 30,000. NF 2 is characterized by bilateral vestibular schwannomas, as well as meningiomas, ependymomas and gliomas. Currently, surgical resection and radiotherapy represent the mainstay of treatment, although new studies suggest a role for certain chemotherapeutic agents. Intravenous administration of Bevacizumab (Avastin, Genetech Pharmaceuticals) has been shown to be active in the treatment of vestibular schwannomas. The IV route of administration, however, carries a risk of known systemic side-effects such as bowel perforation, wound dehiscence and pulmonary embolism. In addition, the percentage of drug that reaches the tumor site may be restricted by the blood tumor barrier. This report describes the super-selective intra-arterial infusion of Bevacizumab following blood brain barrier disruption for the treatment of vestibular schwannomas in three patients with Neurofibromatosis type 2. It represents the first time such a technique has been performed for this disease. Additionally, this method of drug delivery may have important implications in the treatment of patients with vestibular schwannomas associated with Neurofibromatosis type 2.
AuthorsH A Riina, J-K Burkhardt, A Santillan, L Bassani, A Patsalides, J A Boockvar
JournalInterventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences (Interv Neuroradiol) Vol. 18 Issue 2 Pg. 127-32 (Jun 2012) ISSN: 1591-0199 [Print] United States
PMID22681725 (Publication Type: Case Reports, Journal Article)
Chemical References
  • Angiogenesis Inhibitors
  • Antibodies, Monoclonal, Humanized
  • Bevacizumab
Topics
  • Adult
  • Angiogenesis Inhibitors (administration & dosage)
  • Angiography, Digital Subtraction
  • Antibodies, Monoclonal, Humanized (administration & dosage)
  • Bevacizumab
  • Blood-Brain Barrier
  • Cerebral Angiography
  • Female
  • Humans
  • Infusions, Intra-Arterial
  • Magnetic Resonance Angiography
  • Male
  • Middle Aged
  • Neurofibromatosis 2 (complications)
  • Neuroma, Acoustic (drug therapy, etiology)
  • Treatment Outcome

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