Image-guided Ommaya reservoir insertion for intraventricular chemotherapy: a retrospective series

Background: In 1963, Ayub Ommaya proposed a surgical technique for placement of a subcutaneous reservoir and pump to allow access to intraventricular cerebrospinal fluid (CSF). Currently, the most common indication for Ommaya reservoir insertion in adults is for patients with hematologic or leptomeningeal disorders who require repeated injection of chemotherapy into the CSF space. Historically, the intraventricular catheter has been inserted blindly based on anatomical landmarks. The purpose of this study was to determine short-term complication rates from Ommaya reservoir placement in the image-guidance era. Methods: We retrospectively evaluated all operative cases of image-guided Ommaya reservoir insertion from 2004-2014 by the senior author (JFM). Patient demographic data and peri-operative complications were collected. Results: We identified 28 patients over the study period (43.3+/-17.3 years; 64.3% male). Indications for placement included acute lymphoblastic leukemia, diffuse large B-cell lymphoma, and leptomeningeal carcinomatosis. There was one asymptomatic peri-operative intracranial hemorrhage (3.6%), and one early infection (3.6%). All catheters were well-positioned and functional. Conclusions: In our retrospective single-centre case series, all catheters were placed accurately. Our results support routine use of intra-operative image guidance for proximal catheter insertion in elective Ommaya reservoir placement for intraventricular chemotherapy.

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SCDT-17. DECREASED OPERATIVE COMPLICATIONS WITH IMAGE-GUIDED OMMAYA RESERVOIR INSERTION: SYSTEMATIC REVIEW AND META-ANALYSIS

Neuro-Oncology ◽

10.1093/neuonc/nox168.1100 ◽

2017 ◽

Vol 19 (suppl_6) ◽

pp. vi268-vi268

Author(s):

Jonathan Lau ◽

Suzanne Kosteniuk ◽

Tom Walker ◽

Alla Iansavichene ◽

David Macdonald ◽

...

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Ommaya Reservoir ◽

Image Guided ◽

Operative Complications

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The Comparative Treatment of Intraventricular Chemotherapy by Ommaya Reservoir vs. Lumbar Puncture in Patients With Leptomeningeal Carcinomatosis

Frontiers in Oncology ◽

10.3389/fonc.2018.00509 ◽

2018 ◽

Vol 8 ◽

Cited By ~ 7

Author(s):

Mariano Montes de Oca Delgado ◽

Bernardo Cacho Díaz ◽

José Santos Zambrano ◽

Vicente Guerrero Juárez ◽

Manuel Salvador López Martínez ◽

...

Keyword(s):

Lumbar Puncture ◽

Leptomeningeal Carcinomatosis ◽

Ommaya Reservoir ◽

Intraventricular Chemotherapy ◽

Comparative Treatment

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Intraoperative Chemotherapy for Leptomeningeal Metastases After Ommaya Placement

10.21203/rs.3.rs-368679/v1 ◽

2021 ◽

Author(s):

Oluwaseun Adeola Omofoye ◽

John S Yu ◽

Ray M Chu

Keyword(s):

Wound Healing ◽

Central Nervous System Lymphoma ◽

Leptomeningeal Metastasis ◽

Therapeutic Benefit ◽

Leptomeningeal Metastases ◽

Ommaya Reservoir ◽

Intraventricular Chemotherapy ◽

Common Diagnosis ◽

Catheter Malfunction ◽

Intraventricular Infusion

Abstract IntroductionThere is a wide variety in the timing of the first intraventricular chemotherapy dose after Ommaya reservoir placement. Given the rapid nature of leptomeningeal metastasis, it is important to avoid any delays in treatment in order to have the optimal therapeutic benefit. We present the first series of immediate intraoperative intraventricular infusion of chemotherapy after Ommaya placement.MethodsA single-institution, retrospective review of twenty patients who underwent surgical placement of an Ommaya reservoir from 2012 to 2020 and had intraoperative infusion of chemotherapy was conducted. Inclusion criteria consisted of patients 18 years and older with a diagnosis of leptomeningeal metastases, central nervous system lymphoma or leukemia. Outcomes such as leukoencephalopathy, wound healing, intracranial hemorrhage, catheter malfunction, Ommaya days, mortality, and other complications were reviewed.ResultsThe mean patient age was 55.1 years and the most common diagnosis was breast cancer (40%). All catheters were placed into the ventricular system, and there were no wound healing complications, infections or symptomatic leukoencephalopathy. Intraventricular chemotherapy was administered for a total of 201 cycles and a mean of 10 times per patient. The number of Ommaya days ranged from 7 to 2177, with a mean of 326.5 days, and 30-day mortality was 10%.Conclusions Ommaya reservoirs are effective intraventricular delivery mechanism for chemotherapy in patients with leptomeningeal metastases. Endoscopy-assisted placement of Ommaya catheters provides a real-time, visual confirmation of adequate placement. Immediate intraoperative intraventricular infusion of chemotherapy after Ommaya placement is safe, effective, and may increase efficiency in time to treatment for patients.

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BMET-33. MORBIDITY AND MORTALITY OF OMMAYA RESERVOIR PLACEMENT FOR INTRAVENTRICULAR CHEMOTHERAPY

Neuro-Oncology ◽

10.1093/neuonc/now212.133 ◽

2016 ◽

Vol 18 (suppl_6) ◽

pp. vi33-vi33

Author(s):

Jonathan C. Lau ◽

David R. Macdonald ◽

Joseph Megyesi

Keyword(s):

Ommaya Reservoir ◽

Morbidity And Mortality ◽

Intraventricular Chemotherapy

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Complications associated with intraventricular chemotherapy in patients with leptomeningeal metastases

Journal of Neurosurgery ◽

10.3171/jns.1997.87.5.0694 ◽

1997 ◽

Vol 87 (5) ◽

pp. 694-699 ◽

Cited By ~ 109

Author(s):

Marc C. Chamberlain ◽

Patty A. Kormanik ◽

David Barba

Keyword(s):

Hodgkin’S Lymphoma ◽

Leptomeningeal Metastases ◽

Ommaya Reservoir ◽

Hodgkin's Lymphoma ◽

Content Type ◽

Non Hodgkin’S Lymphoma ◽

Intraventricular Chemotherapy ◽

Non Hodgkin's Lymphoma ◽

Catheter Infections ◽

Fine Print

✓ The authors studied complications associated with intraventricular chemotherapy in patients with leptomeningeal metastases (LM). One hundred twenty consecutive patients with LM (71 females and 49 males) ranging in age from 10 to 72 years (median 42 years) were treated with involved-field radiotherapy and intraventricular chemotherapy using an Ommaya reservoir and intraventricular catheter system. The diagnosis of LM was determined by a combination of clinical presentation (114 patients); cerebrospinal fluid cytological studies (100); or neuroradiographic studies (42). Systemic tumor histological findings included breast (34 patients); non-Hodgkin's lymphoma (22); melanoma (16); primitive neuroectodermal tumors including medulloblastoma (10); glial neoplasms, leukemia, small cell lung, nonsmall cell lung, and colon (six each); prostate and kidney (three each); and gastric cancers (two). Sixteen patients, all with non-Hodgkin's lymphoma, also had acquired immune deficiency syndrome. Patients received one to four (median two) chemotherapeutic drugs and underwent a total of 1110 cycles of intraventricular chemotherapy (median 10). Intraventricular chemotherapy administration and diagnostic Ommaya reservoir punctures totaled 4400, with a median of 46 per patient. Complications included aseptic/chemical meningitis (52 patients); myelosuppression due to intraventricular chemotherapy (21); catheter-related infections (nine); unidirectional catheter obstruction (six); intraventricular catheter malpositioning (two); Ommaya reservoir exposure (two); leukoencephalopathy (two); and chemotherapy-related myelopathy (one). There were no treatment-related deaths; however, seven patients (6%) required additional surgery for either catheter repositioning (two) or reservoir removal (five). Seven patients with catheter-related infections were treated successfully with intraventricular and systemic antibiotic drugs, thereby preserving the Ommaya system. The authors conclude that Ommaya reservoirs are convenient and pharmacologically rational systems for administering intraventricular chemotherapy. Overall, serious complications requiring surgery are infrequent (6%) and most often secondary to catheter infections, Ommaya reservoir exposure, or initial catheter malpositioning. In the majority of instances, catheter infections may be managed medically, as may the most common complications of intraventricular chemotherapy including aseptic meningitis (43% of patients) and myelosuppression (18%).

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