Elucidating the utility of neuro-navigation in reducing malposition rates in Ommaya reservoir placement: 23-year operative experience at the Louisiana State University.

Abstract

Variability exists with the use of neuro-navigation in the placement of Ommaya reservoir. In the setting of recent healthcare reforms in the United States that are focused on cost-containment strategies, we discuss from our experience at the Louisiana State University, Shreveport, if the use of high-cost stealth-guided navigation technique reduces malposition rates over free-hand placement. A retrospective cohort analyses on 146 patients that underwent placement of Ommaya reservoir between 1991 and 2014 using free-hand and neuro-navigated technique was performed. Primary endpoint was to evaluate the differences in rates of malposition across these two placement techniques. The mean age of our cohort was 44.85 ± 15.05 years and 45% patients were female. We did not find any statistical differences for complications rates including infections (8.3% vs 9.2%; P = 1.000), hemorrhage (0.0% vs 3.1%; P = 0.551), and repositioning (6.3% vs 8.2%; P = 1.000) across patients that underwent placement of Ommaya reservoir using neuro-navigation and free hand technique. Although placement of Ommaya reservoir is a relatively easier technique as compared to other neurosurgical procedures, based on our experience and literature, we found lower rates of complications in patients who underwent placement via the stealth-guided neuro-navigational approach. Despite not having found any statistical difference in malposition rates between navigated and free-hand implantation of Ommaya reservoirs in our series, it is plausible that the number of technical complications in the neuronavigational group in the early years of acquisition could possibly be attributed to the learning curve, rather than their occuring purely by chance. Nevertheless, considering the increased cost of hospitalization associated with the use of navigational technology, future studies are recommended to weigh the cost-benefit ratio of preferring the neuro-navigational techniques for placement of Ommaya reservoir over the free-hand placement techniques.