Intrathecal Chemotherapy: — What Happens and What It Feels Like
Intrathecal chemotherapy is not a drip and not a tablet. It is an injection into the fluid surrounding your brain and spinal cord, placed where standard treatment cannot reach. The procedure is more straightforward than it sounds.
Medically reviewed by Dr. Bharati Devi Gorantla, Medical Oncologist, MBBS · MD · DM (Adyar, Chennai) · ECMO · MRCP SCE (UK) · Last reviewed September 2026
- Not a drip — It goes directly into the spinal fluid space, not into a vein.
- Why it is needed — The blood-brain barrier stops most standard chemotherapy from reaching the brain and spinal cord.
- Local anaesthetic is used — The procedure should not be painful. You feel a brief sting for the anaesthetic, then numbness.
- Day care, not an admission — Most people go home the same day after a rest period at the centre.
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Intrathecal chemotherapy is injected directly into the fluid surrounding your brain and spinal cord. Standard chemotherapy given by drip or tablet cannot cross the blood-brain barrier, leaving cancer cells there unreachable. This injection bypasses that barrier. Local anaesthetic is used, so the procedure causes little pain.
How is intrathecal chemotherapy given, step by step?
You are positioned
You lie on your side with knees drawn up toward your chest, or sit hunched forward over a pillow. Both positions open the spaces between the vertebrae in your lower back.
Your back is cleaned
The skin over your lower back is cleaned with antiseptic. A sterile drape is placed around the injection site.
Local anaesthetic is given
A small injection of local anaesthetic numbs the skin and tissue beneath. You feel a brief sting, then the area goes numb. The rest of the procedure happens in numb tissue.
The needle is guided in
A thin needle is passed between two vertebrae in your lower back into the space where spinal fluid circulates. You may feel pressure, but not sharp pain.
Spinal fluid may be withdrawn
A small amount of spinal fluid is sometimes taken first for laboratory testing. This is routine and takes only a moment.
The drug is injected
The chemotherapy is injected slowly into the spinal fluid. This takes a few minutes. You stay as still as possible throughout.
You rest afterward
The needle is removed and a small dressing is placed. You lie flat for a period at the centre before going home. This reduces the risk of a headache afterward.
Why can't a drip or tablet reach cancer in the brain?
Your brain and spinal cord are protected by the blood-brain barrier — a dense layer of cells lining blood vessels that tightly controls what passes from the bloodstream into the brain.
This barrier is usually protective. It also means most standard chemotherapy drugs, whether given by drip or by mouth, cannot reach the spinal fluid in amounts that work.
Cancer cells that have spread to the fluid around the brain and spinal cord are hidden behind this barrier where a drip cannot follow. Injecting the drug directly into that fluid bypasses the barrier entirely.
Is the injection painful, and what should you expect afterward?
The local anaesthetic is the sharpest part. You feel a brief sting when it is injected, then the skin and deeper tissue go numb.
During the procedure, you may feel pressure or a strange sensation. If anything feels sharp, say so immediately — more anaesthetic can be given.
A headache that develops after you sit or stand up is the most common side effect. Lying flat and drinking fluids helps. If it is severe or does not improve, tell your team.
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What happens at the centre on the day?
Intrathecal chemotherapy is given as a day procedure at CION centres. You do not need to be admitted overnight.
Before the procedure, your team confirms your blood results, checks your medicines, and answers any questions you have. A trained doctor performs the injection.
You rest at the centre afterward. Most people go home the same day. Your team will tell you what to watch for and who to call if anything concerns you.
What do most people worry about before this procedure?
Could the needle damage my spinal cord?
In adults, the spinal cord ends around the first or second lumbar vertebra. The injection is made below that level, where only nerve roots float freely in fluid. The needle does not reach the cord itself. This is the same anatomical principle that makes epidurals safe during childbirth, and the position is confirmed by the doctor before the needle advances.
Is this the same as the spinal injection given before surgery?
The technique is the same — a needle through the lower back into the spinal fluid space with local anaesthetic applied first. The purpose is different. A surgical spinal block numbs the lower body for an operation. An intrathecal chemotherapy injection places drug into the fluid that bathes the brain and spinal cord. Both use the same lumbar landmark.
Which medicines are given this way?
The drugs most commonly used intrathecally include methotrexate and cytarabine. Your oncologist will tell you which specific drug you are receiving and what role it plays in your treatment plan. Do not start, stop or change any medicine without discussing it with your treating team first.
What side effects can this cause beyond a headache?
Some people feel tired for a day after the procedure. The chemotherapy given this way can, in a proportion of patients, cause temporary neurological effects. Tell your team promptly if you notice any change in your vision, speech, limb strength or thinking in the days following the injection. These are not common, but they are important to report early.
Can children have this procedure?
Yes. Intrathecal chemotherapy is a standard part of treatment for childhood leukaemia. Younger children are usually given sedation or a short general anaesthetic so they remain still and comfortable throughout. Your child's oncology team will explain exactly what is planned and how they will keep your child calm and comfortable on the day.
Did you know?
Before intrathecal treatment became part of standard leukaemia protocols, the brain and spinal fluid were a common site of relapse even when disease elsewhere had responded well.
Adding direct CNS-directed chemotherapy substantially changed this. The blood-brain barrier is the reason this route exists and why it remains in standard care worldwide.
Source: NCCN Guidelines for Acute Lymphoblastic Leukemia
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Frequently asked questions
What conditions is intrathecal chemotherapy used for?
It is most commonly used in leukaemia and some lymphomas, where cancer cells can reach the fluid around the brain and spinal cord. It is also used when cancer has spread from elsewhere to the lining of those structures — called leptomeningeal metastasis. Your oncologist will explain whether it is being given to prevent CNS involvement or to treat disease already there.
How long will the whole visit take?
The injection itself takes only a few minutes. The full visit — preparation, the procedure, and the rest period at the centre afterward — typically takes a few hours. Plan for a half-day. This can vary if spinal fluid is also being taken for testing on the same day.
Can I eat and drink before the procedure?
For most adults, eating and drinking normally beforehand is fine, because the procedure does not require general anaesthesia. If sedation is planned — which is more common for younger children — your team will give you specific fasting instructions. Follow what your team tells you rather than assuming.
Do I need someone to bring me home?
Yes. You should have someone with you for the journey home and for the rest of that day. A post-procedure headache, the position required, and the general effect of the day make driving yourself home unsafe. If you have no one available, tell your team before the procedure day so they can help you plan.
How soon can I return to normal activities?
Most people return to light activities within a day or two. If you develop a post-procedure headache, rest helps more than pushing through it. Avoid strenuous activity until you feel well. Your team will advise on anything specific to your situation.
What should I tell my team before the procedure?
Tell your team about every medicine you take, including herbal remedies and supplements. Mention any allergies, especially to local anaesthetics. If you take blood-thinning medicines including aspirin, ask whether to pause them beforehand. If you have had back surgery or significant spine problems, mention this before the day — it may affect the technique used.
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