Abstract
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.
Highlights
Ommaya reservoir is a valuable neurosurgical tool to deliver regular intraventricular therapy and sample the cerebrospinal fluid (CSF) without the need for serial lumbar punctures [1,2,3,4]
The results of Ommaya placement using the described method were reviewed by the senior author
One patient (4%) had an intracranial mycosis fungoidies infection that required long-term intrathecal antifungal therapy, and the infectious disease team requested an Ommaya for intrathecal therapy
Summary
Ommaya reservoir is a valuable neurosurgical tool to deliver regular intraventricular therapy and sample the cerebrospinal fluid (CSF) without the need for serial lumbar punctures [1,2,3,4]. Since its first description in 1963, multiple papers have been published about techniques for the insertion of Ommaya reservoirs using free-hand, frame-based and image-guided methods, all of which have demonstrated success [2,3,4]. Postoperative infection, typically with grampositive skin organisms, occurs in 5%-8% of patients and stratifies into infections occurring around the time of placement, and delayed infections, typically after recent access of the reservoir [5,6]. We document our technique for imageguided insertion of Ommaya reservoirs and review our results using this technique
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