Acta Neurochirurgica

, Volume 160, Issue 3, pp 539–544 | Cite as

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

  • Jonathan C. Lau
  • Suzanne E. Kosteniuk
  • David R. Macdonald
  • Joseph F. Megyesi
Original Article - Brain Tumors

Abstract

Background

Ayub Ommaya proposed a surgical technique for subcutaneous reservoir and pump placement in 1963 to allow access to intraventricular cerebrospinal fluid (CSF). Currently, the most common indication for Ommaya reservoir insertion (ORI) in adults is for patients with hematologic or leptomeningeal disorders requiring 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 examine short-term complication rates with ORI with image guidance (IG) and without image guidance (non-IG).

Methods

We retrospectively evaluated all operative cases of ORI from 2000 to 2014 by the senior author. Patient demographic data, surgical outcomes, and peri-operative complications were collected. Accurate placement and early (30-day) morbidity or mortality were considered primary outcomes.

Results

Fifty-five consecutive patients underwent ORI by the senior author over the study period (43.5 ± 16.6 years; 40.0% female). Indications for placement included acute lymphoblastic leukemia, diffuse large B-cell lymphoma, and leptomeningeal carcinomatosis. There were seven (12.7%) total complications: three (37.5%) with no-IG versus four (8.5%) with IG. Catheter malpositions were significantly higher in the non-IG group at 37.5% compared to 2.1%. Catheters were also more likely to require multiple passes with non-IG at 25% compare to 0% with IG. There were no early infections in either group.

Conclusions

We demonstrate improved accuracy and decreased complications using an image-guided approach compared with a traditional approach. Our results support routine use of intra-operative image guidance for proximal catheter insertion in elective ORI for intraventricular chemotherapy.

Keywords

Neuronavigation Ommaya reservoir Neurosurgery Neuro-oncology–surgical Imaging 

Abbreviations

3D

Three dimensional

ALL

Acute lymphoblastic leukemia

ASA

American Society of Anesthesiologists

BCL

B-cell lymphoma

CML

Chronic myelogenous leukemia

CSF

Cerebrospinal fluid

CT

Computed tomography

IG

Image guided

LCA

Leptomeningeal carcinomatosis

LHSC

London Health Sciences Centre

MRI

Magnetic resonance imaging

OR

Operating room

ORI

Ommaya reservoir insertion

SPGR

Spoiled gradient recalled (MRI sequence)

Notes

Compliance with ethical standards

Conflict of interest

None.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

Supplementary material

701_2017_3454_MOESM1_ESM.xlsx (37 kb)
ESM 1 (XLSX 37 kb)

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Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2018

Authors and Affiliations

  • Jonathan C. Lau
    • 1
    • 2
    • 3
  • Suzanne E. Kosteniuk
    • 1
  • David R. Macdonald
    • 1
    • 4
  • Joseph F. Megyesi
    • 1
    • 5
  1. 1.Department of Clinical Neurological SciencesWestern UniversityLondonCanada
  2. 2.Imaging Research LaboratoriesRobarts Research InstituteLondonCanada
  3. 3.London Health Sciences CentreUniversity HospitalLondonCanada
  4. 4.London Regional Cancer ProgramLondonCanada
  5. 5.Department of PathologyWestern UniversityLondonCanada

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