====== Vindesine ======

===== Case reports =====
In a [[case report]] + systematic review  
Babaee et al. from:
  - Department of Neurosurgery, University Hospital OWL, Campus Bethel, Bielefeld, NRW, Germany  
  - Institute for Neuroradiology, University Hospital OWL, Campus Bethel, Bielefeld, NRW, Germany  
* **Journal**: [[Brain & Spine]]  
* **Purpose**: Assess outcomes and optimal management—particularly CSF irrigation—following inadvertent intrathecal administration of vinca alkaloids (vindesine or vincristine).  
* **Conclusions**: Intrathecal vinca alkaloids are nearly universally fatal without aggressive intervention; CSF irrigation improves survival odds (40% vs 0%) but survivors suffer severe neurological deficits
((Babaee A, Yasin H, Berger B, Simon M. Inadvertent intrathecal application of vindesine and its neurological outcome: case report and systematic review of the literature. Brain Spine. 2025 Jun 2;5:104292. doi: 10.1016/j.bas.2025.104292. PMID: 40546273; PMCID: PMC12179714.)).
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This paper offers a sobering update, but several critical flaws undermine its impact:

1. **Sampling Bias & Heterogeneity**: The systematic review spans only 31 cases, mixing vincristine and vindesine, with only two vindesine cases. Conclusions drawn from such tiny, heterogeneous groups are inherently unstable.

2. **Publication Bias**: Survival cases are far more likely to be reported, biasing the apparent efficacy of CSF irrigation. Fatal cases without irrigation might be underreported, inflating perceived benefit.

3. **Intervention Confounding**: The 'irrigation' cohort also received varied additional interventions (e.g., plasma, neuroprotectants), yet the analysis lumps them together. Causality cannot be attributed to irrigation alone.

4. **Outcome Assessments Are Superficial**: Neurological deficits are described qualitatively as "very significant," but no standardized scoring or long‑term follow‑up is provided—weakening claims of morbidity and recovery.

5. **Recommendation Overreach**: The authors suggest CSF irrigation as treatment of choice, yet this ignores resource limitations, procedural risks, and lack of prospective evidence. This is premature, even unethical, as a "standard."

6. **Novelty Deficit**: The strategy of irrigation has been reported since at least 2007 (e.g., Qweider et al. case), yet the authors frame this as novel or confirmatory without acknowledging continuity or adding mechanistic insight :contentReference[oaicite:1]{index=1}.

===== Final Verdict =====  
Overstates efficacy of CSF irrigation based on thin, biased evidence; lacks rigor in analysis and fails to offer standardized outcome metrics.  

===== Takeaway for Neurosurgeons =====  
Aggressive CSF lavage may salvage some patients from fatal intrathecal vinca exposure—but expect catastrophic motor deficits. Claims of "treatment of choice" are not yet grounded in robust data.

===== Bottom Line =====  
A useful inventory of prior cases, but it's not high‑level evidence. Strong caution is warranted before adopting irrigation as standard; prospective registry data and functional outcomes are needed.

===== Rating =====  
**3 / 10** — Valuable as a case compendium, but low methodological quality and weak evidence preclude any confident practice changes.