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Letters |

Use of Radiopaque Intraorbital Catheter in the Treatment of Sino-Orbito-Cranial Mucormycosis

Alon Kahana, MD, PhD; Mark J. Lucarelli, MD
Arch Ophthalmol. 2007;125(12):1714-1715. doi:10.1001/archopht.125.12.1714.
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Sino-orbital mucormycosis, especially with intracranial involvement, is a devastating infection affecting mostly immunocompromised patients. When combined with systemic therapy and surgical débridement, intraorbital amphotericin B infusion can be an important adjunctive therapy for orbital mucormycosis.1 Correct placement of the intraorbital catheter can be critical to proper drug delivery. We describe a technique using a barium-embedded neurosurgical catheter for intraorbital drug delivery. Intraoperative fluoroscopy can also be used to assess and adjust catheter tip placement to achieve optimal results.

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Surgical technique and results. A, Radiopaque catheter was used to facilitate visualization. Ten-millimeter marks on the catheter can be used to aid in localization. The Innervision Ventricular Catheter (Medtronic, Inc, Minneapolis, Minnesota) is 15 cm long and made of translucent silicone elastomer containing a barium-impregnated stripe. B, Placement of the intraorbital catheter and externalization through a lateral stab incision. C, Catheter placement after closure. Sagittal (D) and coronal (E) computed tomographic scans of patient 1 revealing excellent position of the radiopaque catheter tip. Sagittal (F) and coronal (G) computed tomographic scans of patient 2 showing the catheter (asterisk) curving inside the orbit and pointing away from the orbital apex. H and I, Intraoperative fluoroscopy allows for localization of the catheter tip. H, Sagittal view before the infusion of iohexol. I, Immediately after iohexol infusion. The infusate (arrow) can reveal the direction of fluid spread.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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