Safe Placement of Ommaya Reservoirs in Thrombocytopenic Patients: One Institutions Experience.

Kimberly Major,Elias Rizk,Abraham Schlauderaff,Amalia Brawley,David E Hale

doi:10.7759/cureus.5291

Abstract

ObjectiveThe purpose of this study was to assess the risk of hemorrhagic complications in thrombocytopenic patients after Ommaya reservoir placement.MethodsBetween 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.ResultsSeven 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.ConclusionsFrom 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.

Highlights

Dr Ayub Ommaya, a pioneering neurosurgeon, originally started placing subcutaneous cerebrospinal fluid reservoirs in 1962 and soon thereafter published his results [1]
Between 2009 and 2017, 192 patients were identified on the National Neoplastic Meningitis Registry and had undergone Ommaya reservoir placement for intrathecal chemotherapy
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

Summary

Introduction

Dr Ayub Ommaya, a pioneering neurosurgeon, originally started placing subcutaneous cerebrospinal fluid reservoirs in 1962 and soon thereafter published his results [1]. This procedure consists of passing a ventricular catheter into the lateral ventricle through a burr hole. There are potential, well-described complications associated with the Ommaya reservoir, including aseptic meningitis, catheter-related infection, catheter malplacement, wound dehiscence, and leakage of cerebrospinal fluid [2, 3]. There is scant literature describing intraparenchymal hemorrhage risk associated with placement of the Ommaya reservoir. Kennedy et al reported a hemorrhagic complication rate of 6.4% (seven out of 109 patients) after stereotactic catheter placement for Ommaya reservoirs, with one patient experiencing preoperative thrombocytopenia [6]

Methods

Results

Conclusion