Distance, Depth and Puncture Angle for Cisterna Magna in Chinese Adults as Read from Magnetic Resonance Imaging

Utility of a flexed neck sagittal magentic resonance imaging sequence for the assessment of cerebellomedullary cistern in dogs

Cerebrospinal fluid (CSF) collection from the cerebellomedullary cistern (CM) of dogs with congenital or acquired cerebellar herniation could lead to serious complications. It is anecdotally more challenging in large brachycephalic breeds possibly due to the increased distance between the skin and CM. The first objective of this study was to assess whether flexed‐neck sagittal magnetic resonance imaging (MRI) sequences would assist in the decision‐making process of collecting CSF from the CM. The second objective was to examine the dimensions of the CM measured in extended and flexed views, and whether cranial index (CI), skull height and body weight correlated with the distance of the CM from the skin surface. Forty‐one dogs of various breeds were included in the study. Measurements were performed on T2‐weighted sagittal sequences acquired in extended and flexed‐neck positions, and transverse sequences acquired in an extended‐neck position. Mild cerebellar herniation was detected in 23/41 (56%) of the flexed‐neck views versus none in the extended views. The CM area was significantly larger in flexed‐neck views than in extended views (p < 0.05). In 29% of the cases (12/41), the trajectory of the needle intersected the cerebellar vermis. There was a positive correlation between the distance of the CM from the skin and body weight (p < 0.05) and skull height (p < 0.05), but not with the CI (p = 0.23). These findings suggest that a flexed‐neck sagittal MRI sequence helps with assessment of the size of the CM and degree of cerebellar herniation, and that skull height and body weight, but not cranial index, affect the distance of the CM from the skin surface.

Programmable Pump for Intrathecal Morphine Delivery to Cisterna Magna: Clinical Implications in Novel Management of Refractory Pain Above Middle Thoracic Vertebrae Level Utilizing a Prospective Trial Protocol and Review

BACKGROUND

The cisterna Intrathecal Drug Delivery system (IDDS) with morphine has proven to be effective in treating refractory cancer pain above the middle thoracic vertebrae level in some countries. However, it has not been fully investigated in others. We designed the current project to investigate the efficacy and safety of cisterna IDDS for pain relief in refractory pain above the middle thoracic vertebrae level in advanced cancer patients.

METHODS

This study protocol allows for eligible cancer patients to receive the cisterna IDDS operation. Pain intensity (Visual Analogue scale, VAS), quality of life (36-Item Short-Form Health Survey, SF-36), and depression (Self-Rating Depression scale, SDS) are assessed along with side effects in the postoperative follow-up visits. Recent literature suggests a potential role for cisterna IDDS morphine delivery for refractory pain states above the middle thoracic level.

CONCLUSION

The results of this study may provide further evidence that cisterna IDDS of morphine can serve as an effective and safe pain relief strategy for refractory pain above the middle thoracic vertebrae level in advanced cancer patients.

Intrathecal Morphine Delivery at Cisterna Magna to Control Refractory Cancer-Related Pain: A Prospective Cohort Study

Background

For patients suffering from primary or metastatic cancer above the middle thoracic vertebrae, refractory pain management still remains a great challenge. Theoretically, inserting a catheter tip into the cisterna magna may be a promising solution. However, at present, there have been no reliable data regarding this novel technique. We therefore investigated the efficacy and safety of an advanced approach for pain relief in a specific population.

Methods

Thirty participants from two hospitals received the intrathecal deliveries of opioid to either one of two sites: cisterna magna (n = 15) or lower thoracic region (n = 15). Pain relief (visual analogue scale, VAS), quality of life (short form (36) health survey, SF-36) as well as depression (self-rating depression scale, SDS) were assessed in the follow-up visits and compared between the two groups.

Results

Patients receiving intrathecal morphine delivery to cisterna magna achieved greater pain improvement indicated as significant decrease of VAS scores at day 1 and 7, and achieved better improvement in physical function (day 7 and 30), role physical (day 7 and 30), body pain (day 7, 30 and 90), general health (day 7, 30 and 90), vitality (day 7, 30 and 90), social function (day 90), role emotional (day 7 and 90), mental health (day 7, 30 and 90) and SDS (day 1 and 7).

Conclusions

Intrathecal morphine delivery to cisterna magna might be an effective and safe technique for patients suffering from cancer at the middle thoracic vertebrae or above to control refractory pain. Trial registration: No. ChiCTR-ONN-17010681.