Editorial

The Dorsal Column of this issue ofBrain features a perspective by Bart Lutters and Peter Koehler that looks back at the history of cisterna magna puncture, a procedure that was first described in detail by James Bourne Ayer in 1920. They point out that adoption of the technique was driven, to a great extent, by the goal of delivering therapeutic agents directly to the CNS, and that its popularity waned as antibiotics that could be administered intramuscularly or intravenously replaced intrathecal anti-meningococcal serum, arsphenamine and ‘salvarsanized’ serum (a cocktail of arsphenamine and the patient’s own serum). Advances in radiology and an appreciation of the risks of the procedure no doubt also contributed to the decline of cisternal puncture.Kehrer (1949) reported four deaths in 8335 personally undertaken procedures, implying a substantially higher rate of complications among practitioners who may have been less keen to publicize their experience. Remarkably, 100 years after its introduction, cisterna magna puncture is back in the news, again because of the need to deliver therapeutic agents to the brain and spinal cord. Studies in rodents, cats, dogs, pigs and non-human primates have shown that adeno-associated viral vectors delivered via the cisternal route, as opposed to via a lumbar puncture, can reach the brain as well as the spinal cord. At least four clinical trials of gene therapy delivered by cisterna magna puncture are currently recruiting, targeting m...
Source: Brain - Category: Neurology Source Type: research