Journal Article

P13.05 Success Rate and Early Morbidity from Image-Guided Ommaya Reservoir Placement for Intraventricular Chemotherapy: Case Series and Systematic Review

J. C. Lau, D. R. Macdonald and J. F. Megyesi

in Neuro-Oncology

Volume 18, issue suppl_4, pages iv69-iv70
Published in print October 2016 | ISSN: 1522-8517
Published online September 2016 | e-ISSN: 1523-5866 | DOI: https://dx.doi.org/10.1093/neuonc/now188.249
P13.05 Success Rate and Early Morbidity from Image-Guided Ommaya Reservoir Placement for Intraventricular Chemotherapy: Case Series and Systematic Review

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Background:

Ayub Ommaya proposed a surgical technique for subcutaneous reservoir and pump placement in 1963 in order 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 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 compare short-term complication rates from traditional versus image-guided Ommaya reservoir placement.

Methods:

We retrospectively evaluated all operative cases of image-guided Ommaya reservoir insertion from 2004–2014 by the senior author (JFM). Patient demographic data, surgical outcomes, and peri-operative complications were collected.

A systematic review was performed using Medline and Embase databases using Medical Subject Headings (MeSH) and relevant keywords as regular expressions (1960 to January 2016). The literature search was limited to the English language. Two reviewers independently screened each article title and abstract for relevance to the research question. Disagreements resulted in automatic inclusion. Studies were included if participants were undergoing first-time intraventricular Ommaya reservoir insertion for chemotherapy with no prior cranial operations. Studies that did not report surgical outcome data were excluded. Accurate placement and early (30-day) morbidity or mortality were considered primary outcomes.

Results:

28 patients underwent image-guided Ommaya reservoir insertion by the senior author (JFM) over the study period (43.3 +/- 17.3 years; 35.7% female). Indications for placement included acute lymphoblastic leukemia, diffuse large B-cell lymphoma, and leptomeningeal carcinomatosis. There were two complications: one asymptomatic peri-operative intracranial hemorrhage (3.6%), and one early infection (3.6%) requiring catheter removal and intravenous antibiotics. All catheters were accurately placed (100% success rate).

The literature search revealed 1659 Embase and 1011 Medline articles for a total of 2670 articles. No randomized controlled trials were identified. Quality of evidence was rated based on the Methodological Index for Non-Randomized Studies (MINORS) score. Data extraction and statistical analysis for the systematic review are in progress.

Conclusions:

Our findings suggest 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 Ommaya reservoir placement for intraventricular chemotherapy.

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Subjects: Medical Oncology ; Neurology

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