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Clinical and Translational Radiation... Jul 2020Large cystic craniopharyngioma management combining cyst puncture through an Ommaya reservoir with hypofractionated stereotactic radiotherapy was evaluated. The planning...
Dosimetric and volumetric outcomes of combining cyst puncture through an Ommaya reservoir with index-optimized hypofractionated stereotactic radiotherapy in the treatment of craniopharyngioma.
Large cystic craniopharyngioma management combining cyst puncture through an Ommaya reservoir with hypofractionated stereotactic radiotherapy was evaluated. The planning optimization was focused on the gradient and selectivity. Punctured and filled cyst treatment plans were compared with a retrospective analysis of volumetric and functional outcomes.
PubMed: 32490217
DOI: 10.1016/j.ctro.2020.05.003 -
Molecular and Clinical Oncology Jul 2020The authors report the case of a 39-year-old woman with leukemic meningitis. A right frontal Ommaya reservoir was placed for intrathecal chemotherapy. During and...
The authors report the case of a 39-year-old woman with leukemic meningitis. A right frontal Ommaya reservoir was placed for intrathecal chemotherapy. During and immediately following the first injection of chemotherapy, the patient developed an episode of nausea, emesis, frontal headache and diarrhea. These same symptoms were later elicited during a second and third administration of chemotherapy. Post-placement head computed tomography showed the tip of the catheter projecting approximately 1.5 cm inferior to the floor of the left frontal ventricle. After a revision of the Ommaya catheter due to suboptimal positioning, subsequent intrathecal chemotherapy administration was tolerated without any of the adverse symptoms previously encountered. The case documents an unusual complication arising from catheter migration in the setting of intrathecal chemotherapy and also demonstrates the value in troubleshooting Ommaya reservoir complications rather than prematurely abandoning its use in favor of lumbar puncture.
PubMed: 32454977
DOI: 10.3892/mco.2020.2032 -
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 -
Neurology India 2020External ventricular drainage (EVD) is one of the commonest procedures in neurosurgical practice to manage acute hydrocephalus. We evaluated the infectious and...
BACKGROUND AND AIMS
External ventricular drainage (EVD) is one of the commonest procedures in neurosurgical practice to manage acute hydrocephalus. We evaluated the infectious and non-infectious complications associated with a modified technique for EVD using an Ommaya reservoir.
METHODS
Ommaya reservoir was placed in all patients who required EVD placement for CSF drainage. CSF drainage was achieved using a needle placed in a non-coring fashion percutaneously into the Ommaya reservoir to achieve CSF drainage externally. CSF was monitored for signs of infection regularly using CSF biochemistry and cultures. CSF infection was defined by a positive culture or a secondary infection in patients with already infected CSF.
RESULTS
59 patients required continuous CSF drainage during the study period from January 2014 to June 2017. 46 (77.96%) patients had non-infected CSF at time of starting drainage and 13 (22.03%) patients required external CSF drainage for primarily infected CSF. The study period had a total of 793 CSF drainage days (Range 3-64 days) with an average of 13.4 days per patient. The cumulative rate of new infection was 5.08%. No ventricular catheter blockage or dislodgement was seen in any of the patients.
CONCLUSIONS
External ventricular drainage through an Ommaya chamber is a safe and effective method and can be used to reduce the catheter related complications like infection, catheter blockage and dislodgement.
Topics: Acute Disease; Adolescent; Adult; Aged; Brain Neoplasms; Catheter-Related Infections; Catheters, Indwelling; Cerebral Intraventricular Hemorrhage; Cerebral Ventriculitis; Child; Child, Preschool; Drainage; Equipment and Supplies; Female; Humans; Hydrocephalus; Infant; Male; Middle Aged; Prosthesis Implantation; Scalp; Subarachnoid Hemorrhage; Ventriculostomy; Young Adult
PubMed: 32415024
DOI: 10.4103/0028-3886.284354 -
Respiratory Medicine Case Reports 2020Large cystic brain metastases from lung cancer are rare but cause substantial central nervous system symptoms that often deprive patients of opportunities to receive...
Large cystic brain metastases from lung cancer are rare but cause substantial central nervous system symptoms that often deprive patients of opportunities to receive anticancer therapy. There are no standard therapeutic strategies against this relentless condition. Here we report a patient with large cystic brain metastases from lung adenocarcinoma successfully controlled with Ommaya reservoir placement and subsequent gamma knife surgery (GKS). A 62-year-old Japanese man presented with left upper extremity paresis. Magnetic resonance imaging revealed large cystic masses in both cerebral hemispheres and multiple brain nodules. Computed tomography of the chest showed irregular nodular shadows in the lower lobe of the right lung with multiple swollen lymph nodes. His performance status (PS) and level of consciousness worsened rapidly. Thus, at that time, we could not perform bronchoscopy with the goal of establishing a pathological diagnosis. Intracystic placement of an Ommaya reservoir followed by GKS dramatically improved his PS and level of consciousness. We were subsequently able to perform bronchoscopy, which resulted in a diagnosis of lung adenocarcinoma with 100% positivity of programmed cell death-1 ligand-1 expression. The patient was started on a 3-week cycle of pembrolizumab. Substantial reduction in tumor size was observed after one course of pembrolizumab treatment. The patient had a partial remission. He has been still receiving pembrolizumab with long-term efficacy. In conclusion, our report suggests that aggressive Ommaya reservoir placement should be considered for large cystic metastatic brain tumors, even in patients with undiagnosed cancer, poor PS, and impaired consciousness.
PubMed: 32373458
DOI: 10.1016/j.rmcr.2020.101069 -
Thoracic Cancer Feb 2020We investigated the risk factors for leptomeningeal carcinomatosis (LMC) and compared clinical efficacies of various treatment modalities including intrathecal (IT)...
Impact of clinicopathologic features on leptomeningeal metastasis from lung adenocarcinoma and treatment efficacy with epidermal growth factor receptor tyrosine kinase inhibitor.
BACKGROUND
We investigated the risk factors for leptomeningeal carcinomatosis (LMC) and compared clinical efficacies of various treatment modalities including intrathecal (IT) chemotherapy in patients with lung adenocarcinoma harboring epidermal growth factor receptor (EGFR) mutations.
METHODS
Using clinical research data from the Asan Medical Center, we retrospectively analyzed data of patients diagnosed with LMC, confirmed via cerebrospinal fluid (CSF) analysis from January 2008 to December 2017.
RESULTS
We identified 1189 patients with lung adenocarcinoma harboring EGFR mutations. Among these, 9.8% had a median duration of 13.5 (interquartile range [IQR] 6.8-23.6) months from the initial lung cancer diagnosis to LMC occurrence. Younger age (hazard ratio [HR] 1.043, P < 0.001), initial metastatic disease (HR 3.768, P < 0.001), and metastasis to the brain (HR 8.682, P < 0.001) or lung (HR 2.317, P = 0.004) were risk factors associated with LMC. Median survival duration from LMC diagnosis was 3.8 (IQR 1.5-8.6) months. Eastern Cooperative Oncology Group performance status score ≤ 2 (HR 0.505, P = 0.007) and insertion of Ommaya reservoir (HR 0.445, P = 0.005) were associated with longer survival. EGFR-tyrosine kinase inhibitor (TKI) conferred survival benefits compared to cytotoxic chemotherapy or best supportive care (HR 2.222, P = 0.018; HR 5.638, P < 0.001, respectively). Although IT chemotherapy showed no survival benefit, it was associated with improved neurologic symptoms and signs and CSF negative conversion.
CONCLUSIONS
Younger age, initial diagnosis of metastatic disease, and metastasis to the brain or different lobes were associated with LMC in patients with EGFR-mutant lung adenocarcinoma. Therapeutic interventions including EGFR-TKIs, cytotoxic chemotherapy, or Ommaya reservoir, and good performance status were related to favorable survival outcomes.
KEY POINTS
Age and disease status were associated with LMC in patients with EGFR-mutant adenocarcinoma, and EGFR-TKI, Ommaya reservoir, and good performance status were related to survival benefit.
Topics: Adenocarcinoma of Lung; Aged; Biomarkers, Tumor; Carcinoma, Non-Small-Cell Lung; ErbB Receptors; Female; Follow-Up Studies; Humans; Lung Neoplasms; Male; Meningeal Carcinomatosis; Middle Aged; Mutation; Neoplasm Metastasis; Protein Kinase Inhibitors; Retrospective Studies; Survival Rate; Treatment Outcome
PubMed: 31910497
DOI: 10.1111/1759-7714.13296 -
Cureus Jul 2019Objective The purpose of this study was to assess the risk of hemorrhagic complications in thrombocytopenic patients after Ommaya reservoir placement. Methods Between...
Objective The purpose of this study was to assess the risk of hemorrhagic complications in thrombocytopenic patients after Ommaya reservoir placement. Methods Between 2009 and 2017, 192 patients were identified on the National Neoplastic Meningitis Registry and had undergone Ommaya reservoir placement for intrathecal chemotherapy. A retrospective chart review was performed to collect the preoperative and postoperative platelet levels, whether or not the patient received any transfusion of platelets, neurological exams, and whether a postoperative head CT was obtained. Using generally accepted recommendations, a platelet level less than 100,000/μL was considered clinically significant and used as our threshold for thrombocytopenia. Results Seven patients (3.6%) were identified as thrombocytopenic in our patient population with platelet counts ranging from 54,000 to 99,000/μL. Primary diagnoses for the seven patients included leukemia, prostate cancer, primary brain cancer (four patients), and lung cancer (non-small-cell lung carcinoma). One patient received platelet transfusions preoperatively. Three patients had a routine head CT obtained postoperatively with no abnormal findings noted. There were no changes in the neurological exam noted in all of the patients included in this study. No clinically significant hemorrhages were identified in our patients. Conclusions From our single institutional experience, we found that thrombocytopenia is fairly uncommon, found in only 3.6% of our patients undergoing placement of Ommaya reservoirs. We did not encounter any increased risks of postoperative hemorrhage in studied thrombocytopenic patients.
PubMed: 31576280
DOI: 10.7759/cureus.5291 -
Zhongguo Fei Ai Za Zhi = Chinese... Aug 2019Leptomeningeal metastasis (LM) is one of the most severe complications of non-small-cell lung cancer (NSCLC), and its incidence is increasing gradually with the progress... (Review)
Review
Leptomeningeal metastasis (LM) is one of the most severe complications of non-small-cell lung cancer (NSCLC), and its incidence is increasing gradually with the progress of targeted therapies. There are currently no standard guidelines for the therapy of LM. Intrathecal chemotherapy is the mainstay of treatment for NSCLC patients with LM, but the optimal drug, administration route and mode, and dosage remain unclear. We report a case of LM from NSCLC, who received the intrathecal chemotherapy with pemetrexed by Ommaya reservoir after prior targeted therapies. This local treatment improved the quality of life, and obtained the clearing of CSF cytology and stable lesions of LM without any notable side effects. After confirmation of LM, the patient has survived 17 months until now. Here we report the first case to demonstrate the potential effectiveness of intrathecal pemetrexed by Ommaya reservoir for the treatment of LM of NSCLC, summarize the safety and effectiveness of intrathecal chemotherapy in combination with related literatures, and provide a new strategy for local treatment of LM in clinical. .
Topics: Antineoplastic Agents; Carcinoma, Non-Small-Cell Lung; Cerebrospinal Fluid; Female; Humans; Infusions, Intraventricular; Lung Neoplasms; Meningeal Neoplasms; Middle Aged; Neoplasm Metastasis; Pemetrexed
PubMed: 31451148
DOI: 10.3779/j.issn.1009-3419.2019.08.12 -
Journal of Nuclear Medicine : Official... Dec 2019Radiation dose estimations are key for optimizing therapies. We studied the role of I-omburtamab (8H9) given intraventricularly in assessing the distribution and...
Radiation dose estimations are key for optimizing therapies. We studied the role of I-omburtamab (8H9) given intraventricularly in assessing the distribution and radiation doses before I-omburtamab therapy in patients with metastatic leptomeningeal disease and compared it with the estimates from cerebrospinal fluid (CSF) sampling. Patients with histologically proven malignancy and metastatic disease to the central nervous system or leptomeninges who met eligibility criteria for I-omburtamab therapy underwent immuno-PET imaging with I-8H9 followed by I-8H9 antibody therapy. Patients were imaged with approximately 74 MBq of intraventricular I-omburtamab via an Ommaya reservoir. Whole-body PET images were acquired at approximately 4, 24, and 48 h after administration and analyzed for dosimetry calculations. Peripheral blood and CSF samples were obtained at multiple time points for dosimetry estimation. Forty-two patients with complete dosimetry and therapy data were analyzed. I-omburtamab PET-based radiation dosimetry estimations revealed mean (±SD) absorbed dose to the CSF for I-8H9 of 0.62 ± 0.40 cGy/MBq, compared with 2.22 ± 2.19 cGy/MBq based on I-omburtamab CSF samples and 1.53 ± 1.37 cGy/MBq based on I-omburtamab CSF samples. The mean absorbed dose to the blood was 0.051 ± 0.11 cGy/MBq for I-omburtamab samples and 0.07 ± 0.04 cGy/MBq for I-omburtamab samples. The effective whole-body radiation dose for I-omburtamab was 0.49 ± 0.27 mSv/MBq. The mean whole-body clearance half-time was 44.98 ± 16.29 h. PET imaging with I-omburtamab antibody administered intraventricularly allows for noninvasive estimation of dose to CSF and normal organs. High CSF-to-blood absorbed-dose ratios are noted, allowing for an improved therapeutic index to leptomeningeal disease and reduced systemic doses. PET imaging-based estimates were less variable and more reliable than CSF sample-based dosimetry.
Topics: Adolescent; Adult; Antibodies, Monoclonal, Murine-Derived; Child; Child, Preschool; Female; Humans; Infant; Iodine Radioisotopes; Male; Meningeal Neoplasms; Neoplasm Metastasis; Positron-Emission Tomography; Radiometry; Tissue Distribution; Young Adult
PubMed: 31405921
DOI: 10.2967/jnumed.118.219576 -
The American Journal of Case Reports Jul 2019BACKGROUND Intraventricular administration of methotrexate (MTX) using an Ommaya reservoir is a useful therapeutic maneuver for malignant CNS involvement in patients...
BACKGROUND Intraventricular administration of methotrexate (MTX) using an Ommaya reservoir is a useful therapeutic maneuver for malignant CNS involvement in patients with hematological malignancies. MTX-induced subacute neurotoxicity is a rare complication that typically progresses with involvement of the basal ganglia. Local toxicity due to misplaced catheters has been described, although the impact of normally positioned catheters on toxicity is not clear. CASE REPORT We report the case of a 21-year-old man diagnosed with stage IV diffuse large B-cell lymphoma who experienced a central nervous system relapse. While receiving intraventricular MTX using an Ommaya reservoir and systemic MTX, he experienced sudden left-side hemiparesis. All diagnostic tests were negative except for altered MRI findings with FLAIR hyperintensity in the basal ganglia and restricted diffusion in the same location that followed the track of the Ommaya catheter. The syndrome resolved after administration of high-dose steroids, and the patient received subsequent MTX courses without recurrence. CONCLUSIONS MTX-induced neurotoxicity is a rare adverse event related to systemic and intrathecal administration of the drug. Many cases of Ommaya-related CNS symptoms have been described, although most were related to misplaced or malfunctioning catheters. Here we present a case of subacute MTX toxicity affecting the area around a correctly positioned catheter, suggesting that the catheter track could be more susceptible to MTX-induced toxicity.
Topics: Antimetabolites, Antineoplastic; Catheters, Indwelling; Diagnosis, Differential; Humans; Lymphoma, Large B-Cell, Diffuse; Male; Methotrexate; Neurotoxicity Syndromes; Paresis; Young Adult
PubMed: 31295228
DOI: 10.12659/AJCR.915632