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2016 ; 30
(6
): 469-80
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English Wikipedia
Perispinal Delivery of CNS Drugs
#MMPMID27120182
Tobinick EL
CNS Drugs
2016[Jun]; 30
(6
): 469-80
PMID27120182
show ga
Perispinal injection is a novel emerging method of drug delivery to the central
nervous system (CNS). Physiological barriers prevent macromolecules from
efficiently penetrating into the CNS after systemic administration. Perispinal
injection is designed to use the cerebrospinal venous system (CSVS) to enhance
delivery of drugs to the CNS. It delivers a substance into the anatomic area
posterior to the ligamentum flavum, an anatomic region drained by the external
vertebral venous plexus (EVVP), a division of the CSVS. Blood within the EVVP
communicates with the deeper venous plexuses of the CSVS. The anatomical basis
for this method originates in the detailed studies of the CSVS published in 1819
by the French anatomist Gilbert Breschet. By the turn of the century, Breschet's
findings were nearly forgotten, until rediscovered by American anatomist Oscar
Batson in 1940. Batson confirmed the unique, linear, bidirectional and retrograde
flow of blood between the spinal and cerebral divisions of the CSVS, made
possible by the absence of venous valves. Recently, additional supporting
evidence was discovered in the publications of American neurologist Corning.
Analysis suggests that Corning's famous first use of cocaine for spinal
anesthesia in 1885 was in fact based on Breschet's anatomical findings, and
accomplished by perispinal injection. The therapeutic potential of perispinal
injection for CNS disorders is highlighted by the rapid neurological improvement
in patients with otherwise intractable neuroinflammatory disorders that may ensue
following perispinal etanercept administration. Perispinal delivery merits
intense investigation as a new method of enhanced delivery of macromolecules to
the CNS and related structures.
|*Drug Delivery Systems
[MESH]
|Anti-Inflammatory Agents, Non-Steroidal/*administration & dosage/therapeutic use
[MESH]
|Central Nervous System Agents/*administration & dosage/therapeutic use
[MESH]
|Central Nervous System Diseases/*drug therapy
[MESH]