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World Neurosurgery Dec 2019Treatment of cystic craniopharyngiomas can be challenging and recurrences are frequent, even after total resection. In selected cases, less-aggressive surgery with the... (Review)
Review
OBJECTIVE
Treatment of cystic craniopharyngiomas can be challenging and recurrences are frequent, even after total resection. In selected cases, less-aggressive surgery with the sole drainage of the cyst reliefs symptoms caused by mass effect and represents a valid alternative option, notably in pediatric population. We herein analyze a series of adult cystic craniopharyngiomas, managed with Ommaya Reservoir implant, focusing on local tumor control and eventual complications.
METHODS
In total, 11 nonconsecutive adult cystic craniopharyngiomas (7 recurrent lesions) were treated with Ommaya Reservoir System (ORS), in 2 neurosurgical centers. ORS was placed in 9 cases using minimally invasive procedures: 6 burr-hole endoscopic insertion and 3 navigated electromagnetic placement; in the remaining 2 patients, the Ommaya reservoir was used as a shunt to prevent cyst recollection during a transcranial approach.
RESULTS
The main presenting symptoms were visual impairment (75%), cognitive and behavioral disorders (66.7%), hypopituitarism (38%), headache (30.8%), and hypothalamic obesity (8%). The median follow-up period was 41.4 months. In all patients, the visual function and intracranial hypertension improved after decompression. Local tumor control was accomplished in 8 patients (72.7%), without the need of adjuvant treatments. The endoscopic vision carried similar rates of tumor control than stereotaxy (75% vs. 66.7%).
CONCLUSIONS
In selected patients, tailored procedures are required to achieve long-term tumor control and as well limit surgery-related morbidity. ORS could represent a safe and effective treatment option for cystic craniopharyngiomas, providing also reduced surgical-related morbidity, especially in recurrent lesions and in patients not suitable for radical surgery.
Topics: Adolescent; Adult; Aged; Cognitive Dysfunction; Craniopharyngioma; Cysts; Drainage; Electromagnetic Fields; Female; Headache; Humans; Hypopituitarism; Intracranial Hypertension; Male; Mental Disorders; Middle Aged; Neuroendoscopy; Neurosurgical Procedures; Pituitary Neoplasms; Retrospective Studies; Stereotaxic Techniques; Vision Disorders; Young Adult
PubMed: 31400528
DOI: 10.1016/j.wneu.2019.07.217 -
Cureus Apr 2020Ommaya reservoir insertion is an elective neurosurgical procedure to deliver repeated intraventricular therapy, but placement can be complicated by malposition of the...
Ommaya reservoir insertion is an elective neurosurgical procedure to deliver repeated intraventricular therapy, but placement can be complicated by malposition of the catheter, clogging, infection or poor postoperative cosmesis. Here, we describe the technique used by the senior author for accurate placement including preassembly of the reservoir and catheter, and recessing of the reservoir so that others may consider the technique for their practice. Results in a consecutive series of 27 Ommaya placements were reviewed. Catheter tip placement accuracy, complications and surgical times were reported. Indications were leptomeningeal cancer or infection. Postoperative imaging showed the catheter tip was located in the frontal horn (96%) or body (4%) of the ipsilateral lateral ventricle. The median surgical time was 36 minutes (range 17-63 minutes). There were no parenchymal or subarachnoid hemorrhages. Infections occurred in 7% (n=2) of cases, and both infections presented greater than 60 days postoperative. In conclusion, we have found that image guidance can optimize accuracy in placement, that preassembly of the reservoir and catheter may be used with a 25-gauge spinal needle stylet to minimize risk of clogging during placement, and that recessing of the reservoir produces the best aesthetic result.
PubMed: 32432009
DOI: 10.7759/cureus.7731 -
No Shinkei Geka. Neurological Surgery Nov 2022Childhood hydrocephalus is a highly diverse disease caused by various factors, and most surgical treatments are performed during infancy. Despite the diversity of...
Childhood hydrocephalus is a highly diverse disease caused by various factors, and most surgical treatments are performed during infancy. Despite the diversity of hydrocephalus pathologies, treatment options are limited. It is difficult for pediatric neurosurgeons to select and perform appropriate surgical procedures for neonates and infants. Treatment options for hydrocephalus are broadly divided into permanent and temporary. Permanent treatments include cerebrospinal fluid shunt and endoscopic third ventriculostomy; temporary treatment entails cerebrospinal fluid drainage using lumbar puncture and intermittent cerebrospinal fluid drainage with an Ommaya reservoir, ventricular drainage, and ventriculosubgaleal shunt. This article describes in detail Ommaya reservoir placement and ventricular drainage as representative procedures for temporarily treating hydrocephalus.
Topics: Infant, Newborn; Infant; Humans; Child; Cerebral Hemorrhage; Retrospective Studies; Hydrocephalus; Drainage; Cerebrospinal Fluid Leak
PubMed: 36426516
DOI: 10.11477/mf.1436204682 -
Acta Neurologica Belgica Mar 2017The objective is to study the role of Ommaya reservoir in the treatment of cryptococcal meningitis. The clinical data of 42 patients with cryptococcal meningitis were...
The objective is to study the role of Ommaya reservoir in the treatment of cryptococcal meningitis. The clinical data of 42 patients with cryptococcal meningitis were retrospectively studied. The Ommaya group included 20 patients, who were treated with Amphotericin B (Am B) and Ommaya reservoir implantation. The non-Ommaya group contained 22 patients, who were just treated with Amphotericin B (Am B). In the Ommaya group (surgical group), all 20 patients with Ommaya reservoir were fully recovered, and their average hospital stay period and average treatment period with Amphotericin B were 105.3 ± 18.3 and 75.0 ± 18.1 days, respectively. In the non-Ommaya group (control group), 16 patients were fully recovered and the average hospital stay period and average treatment period with Amphotericin B of these 22 patients were 139.6 ± 29.5 and 150.0 ± 32.2 days, respectively. In the surgical group, average period of cryptococcus disappearance was 20 ± 8 days, while in the control group, that was 35 ± 10 days. The clinical efficacy was better in surgical group than control group (P < 0.05). Ommaya reservoir implantation is a valuable approach in the treatment of cryptococcal meningitis and can improve the cure rate, decrease mortality, and shorten the period of treatment.
Topics: Adult; Drainage; Female; Humans; Male; Meningitis, Cryptococcal; Middle Aged; Neurosurgical Procedures; Postoperative Complications; Retrospective Studies; Treatment Outcome
PubMed: 27492153
DOI: 10.1007/s13760-016-0682-6 -
Journal of Neurosurgery. Pediatrics Oct 2023Craniopharyngiomas with a predominant cystic component are often seen in children and can be treated with an Ommaya reservoir for aspiration and/or intracystic therapy.... (Review)
Review
OBJECTIVE
Craniopharyngiomas with a predominant cystic component are often seen in children and can be treated with an Ommaya reservoir for aspiration and/or intracystic therapy. In some cases, cannulation of the cyst can be challenging via a stereotactic or transventricular endoscopic approach due to its size and proximity to critical structures. In such cases, a novel placement technique for Ommaya reservoirs via a lateral supraorbital incision and supraorbital minicraniotomy has been used.
METHODS
The authors conducted a retrospective chart review of all children undergoing supraorbital Ommaya reservoir insertion from January 1, 2000, to December 31, 2022, at the Hospital for Sick Children, Toronto. The technique involves a lateral supraorbital incision and a 3 × 4-cm supraorbital craniotomy, with identification and fenestration of the cyst under the microscope and insertion of the catheter. The authors assessed baseline characteristics and clinical parameters of surgical treatment and outcome. Descriptive statistics were conducted. A review of the literature was performed to identify other studies describing a similar placement technique.
RESULTS
A total of 5 patients with cystic craniopharyngioma were included (3 male, 60%) with a mean age of 10.20 ± 5.72 years. The mean preoperative cyst size was 11.6 ± 3.7 cm3, and none of the patients suffered from hydrocephalus. All patients suffered from temporary postoperative diabetes insipidus, but no new permanent endocrine deficits were caused by the surgery. Cosmetic results were satisfactory.
CONCLUSIONS
This is the first report of lateral supraorbital minicraniotomy for Ommaya reservoir placement. This is an effective and safe approach in patients with cystic craniopharyngiomas, which cause local mass effect but are not amenable to traditional Ommaya reservoir placement stereotactically or endoscopically.
Topics: Adolescent; Child; Child, Preschool; Humans; Male; Craniopharyngioma; Cysts; Drug Delivery Systems; Pituitary Neoplasms; Retrospective Studies; Female
PubMed: 37410604
DOI: 10.3171/2023.5.PEDS2390 -
Journal of Neurosurgical Sciences Jun 2023Delayed subdural fluid collections can occur after Ommaya reservoir placement and can cause neurological symptoms and interfere with treatment. We performed a...
BACKGROUND
Delayed subdural fluid collections can occur after Ommaya reservoir placement and can cause neurological symptoms and interfere with treatment. We performed a retrospective chart review to study risk factors for delayed subdural fluid collections and clinical outcomes.
METHODS
Retrospective chart review was performed for patients undergoing Ommaya reservoir placement between 2010-2019 at our institution.
RESULTS
Out of 53 patients who had Ommaya reservoir placement during the study period, 11 developed delayed subdural fluid collections (21%). HIV infection was the only statistically significant risk factor (P=0.001, Fisher's Exact Test). Thrombocytopenia, ventricle size, use of the reservoir, and suboptimal catheter placement were not associated with development of delayed subdural fluid collections. 2 patients, both HIV positive, required surgical evacuation.
CONCLUSIONS
Delayed subdural fluid collections occur in a significant minority of patients after Ommaya reservoir placement, and some patients require surgical intervention. HIV infection is associated with a higher risk of development of delayed subdural fluid collections. This patient subpopulation may benefit from closer monitoring or adjustment of management protocols.
Topics: Humans; Retrospective Studies; HIV Infections; Cerebral Ventricles; Drainage; Craniotomy
PubMed: 33297611
DOI: 10.23736/S0390-5616.20.05187-5 -
The Journal of Infection Apr 2003The Ommaya reservoir system has been used for the treatment of chronic central nervous system infections and intracranial tumors for more than three decades. The... (Review)
Review
The Ommaya reservoir system has been used for the treatment of chronic central nervous system infections and intracranial tumors for more than three decades. The majority of reported Ommaya reservoir infections occur proximate to the time the device is accessed. A review of the literature reveals that late onset of reservoir infection is quite rare. We report a case of Ommaya reservoir infection due to Staphylococcus aureus that was diagnosed seven years after its insertion and usage for intracerebral non-Hodgkin's lymphoma and review the literature on the microbiology and management of Ommaya reservoir infections.
Topics: Adolescent; Adult; Catheters, Indwelling; Child; Female; Humans; Male; Middle Aged; Staphylococcal Infections; Staphylococcus aureus; Time Factors
PubMed: 12643873
DOI: 10.1053/jinf.2002.1111 -
Child's Nervous System : ChNS :... May 2024Mucopolysaccharidosis type II (MPS II) results from the genetic deficiency of a lysosomal enzyme and is associated with central nervous system (CNS) dysfunction. In... (Review)
Review
Ommaya reservoir placement using ultrasound guidance via anterior fontanelle combined with frameless electromagnetic neuronavigation in patients with mucopolysaccharidosis type 2: Case reports and review of the literature.
Mucopolysaccharidosis type II (MPS II) results from the genetic deficiency of a lysosomal enzyme and is associated with central nervous system (CNS) dysfunction. In Japan, in addition to intravenous enzyme administration, intracerebroventricular enzyme delivery through the Ommaya reservoir has recently gained approval. Nevertheless, the ideal approach for safely implanting the reservoir into the narrow ventricles of infantile MPS II patients remains uncertain. In this report, we present two cases of successful reservoir placement in infantile MPS II patients using ultrasound guidance via the anterior fontanelle, coupled with flameless electromagnetic neuronavigation.
Topics: Humans; Neuronavigation; Mucopolysaccharidosis II; Cranial Fontanelles; Electromagnetic Phenomena; Drug Delivery Systems
PubMed: 38165414
DOI: 10.1007/s00381-023-06265-9 -
Zhurnal Voprosy Neirokhirurgii Imeni N.... 2014In modern neuro-oncology and onco-hematology, intraventricular injection of chemotherapeutic agents (most typically, methotrexate) is an inevitable part of many... (Review)
Review
In modern neuro-oncology and onco-hematology, intraventricular injection of chemotherapeutic agents (most typically, methotrexate) is an inevitable part of many protocols for treating patients with malignant tumors of the CNS, neuroleukemia, CNS lymphomas and some other disorders. A ventricular catheter system (also known as the Ommaya reservoir) is used to provide repeated injection of chemotherapeutic agents to cerebral ventricles. The use of modern neuronavigation systems allows one to place Ommaya reservoir in patients with narrow and slit-like ventricles. Material and methods. During the period between March 2012 and October 2013, 27 patients underwent stereotactic placement of the Ommaya reservoir using a Cart II optical neuronavigation system (Stryker) at the Dmitry Rogachev Federal Scientific and Clinical Center of Pediatric Hematology, Oncology and Immunology. The patients for stereotactic placement of a ventricular catheter were selected on a subjective basis (small ventricular size was the criterion for selection). In one patient, the surgery for placement of the Ommaya reservoir was combined with stereotactic biopsy. Results. In all patients, a ventricular catheter was placed in the anterior horn of the lateral ventricle on the first try; no intraoperative complications were observed. Conclusions. Frameless navigation is an illustrative, mobile, and multifunctional method. The same device can be used to perform brain, transsphenoidal, ENT, and spine surgeries, as well as orthopedic interventions. Today, neuronavigation systems are used in neurosurgical operating rooms and make it possible to avoid using stereotactic frames in most cases.
Topics: Catheters, Indwelling; Cerebral Ventricles; Child; Humans; Models, Anatomic; Neuronavigation; Neurosurgical Procedures; Tomography, X-Ray Computed
PubMed: 25146655
DOI: No ID Found