Suboccipital lateral injection of intrathecal chemotherapy in a patient with mantle cell lymphoma

Background: Even today patients who suffer from mantle cell
lymphoma have a poor prognosis, especially when the CNS is
involved. To confirm the diagnosis of meningeosis lymphomatosa,
asservation of the liquor cerebrospinalis is necessary. During this
procedure, intrathecal chemotherapy may be given if there is
clinical evidence of meningeosis. If lumbar puncture cannot be
performed, a lateral suboccipital puncture may be an alternative
approach. Patient and Methods: We report the case of a 65-year-old
patient who suffered from mantle cell lymphoma stage IV. The
patient presented with symptoms of progressive paraparesis of both
legs and incontinence, with tumor mass intradural from the 12th
thoracic vertebra to the level of S1. During irradiation, the
patient developed symptoms of diffuse meningiosis lymphomatosa. The
conventional lumbar puncture was impossible, because of tumor
present in the thoracico-lumbar junction. Results: A suboccipital
puncture was performed for both collecting cerebrospinal fluid and
application of chemotherapy ( cytosine arabinoside/dexamethasone).
This lead to remarkable improvement of the patient's clinical
symptoms. Conclusion: The suboccipital cervical puncture was
performed without complications. A variation of the intrathecal
approach is described, which may serve as alternative when
conventional lumbar puncture is not possible.