Treatment of Massive Intrathecal Methotrexate Overdose by Ventriculolumbar Perfusion

Abstract

INTRATHECAL chemotherapy is now widely used in the prophylaxis and treatment of neoplasms that metastasize to the central nervous system. Over 20 years of experience with intrathecal methotrexate therapy has resulted not only in improved survival rates in some cancers^{1 2 3} but also in the recognition of a number of acute and chronic toxicities. Exposure to methotrexate in high concentrations or for sustained periods is clearly neurotoxic, and various dosage recommendations have been suggested to avoid neurotoxicity.^{4 , 5} Clinical studies indicate that adults should receive a maximal intrathecal dose of 12.5 mg of methotrexate to avoid acute clinical neurotoxicity.Cases of inadvertent . . .