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Safety of Ommaya reservoirs in children with brain tumors: a 20-year experience with 5472 intraventricular drug administrations in 98 patients

  • Clinical Study
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Abstract

The Ommaya reservoir facilitates repetitive delivery of drugs into the CSF and is a pharmacologically rational system for intrathecal chemotherapy. Because previous studies have found a high rate of infection and other complications we herein studied our experience with this device. Between 1993 and 2013, 98 children with brain tumors aged 3 months to 21 years (38 ≤ 3 years) had an Ommaya reservoir placed. All patients received perioperative antibiotics. Only specially trained personnel that followed standardized guidelines were allowed to access the reservoir. As of April 2014, 5,472 chemotherapy instillations were performed amounting to a median of 36 deliveries (2–280) per reservoir. Ommaya reservoirs were present for 199,956 days and a median of 1,336 days per device. Median survival of the 52 patients still alive is 7.5 years. Only one patient developed an Ommaya reservoir infection (1 %) that could be temporarily sterilized but eventually required Ommaya reservoir explantation. Early complications related to Ommaya reservoir placement occurred in two patients, in one catheter malposition was corrected intraoperatively and in the other kinking of the catheter at the burr-hole required minor surgical correction. Two delayed complications requiring surgical revision included malpositioning of the catheter tip after rapid shrinkage of the ventricles and disconnection of the ventricular catheter after 24 accesses. No leucodystrophic changes occurred along the catheter track. In conclusion, Ommaya reservoirs are safe and complications infrequent providing that all personnel involved in implanting and subsequently accessing the device are specially trained and pay meticulous attention to strict aseptic conditions.

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References

  1. Packer RJ (1999) Brain tumors in children. Arch Neurol 56:421–425

    Article  PubMed  CAS  Google Scholar 

  2. Radcliffe J, Packer RJ, Atkins TE, Bunin GR, Schut L, Goldwein JW, Sutton LN (1992) Three- and four-year cognitive outcome in children with noncortical brain tumors treated with whole-brain radiotherapy. Ann Neurol 32:551–554

    Article  PubMed  CAS  Google Scholar 

  3. Silber JH, Radcliffe J, Peckham V, Perilongo G, Kishnani P, Fridman M, Goldwein JW, Meadows AT (1992) Whole-brain irradiation and decline in intelligence: the influence of dose and age on IQ score. J Clin Oncol 10:1390–1396

    PubMed  CAS  Google Scholar 

  4. Dennis M, Spiegler BJ, Hetherington CR, Greenberg ML (1996) Neuropsychological sequelae of the treatment of children with medulloblastoma. J Neuro-oncol 29:91–101

    Article  CAS  Google Scholar 

  5. Mayer R, Sminia P (2008) Reirradiation tolerance of the human brain. Int J Radiat Oncol Biol Phys 70:1350–1360

    Article  PubMed  CAS  Google Scholar 

  6. Rutkowski S, Bode U, Deinlein F, Ottensmeier H, Warmuth-Metz M, Soerensen N, Graf N, Emser A, Pietsch T, Wolff JE, Kortmann RD, Kuehl J (2005) Treatment of early childhood medulloblastoma by postoperative chemotherapy alone. N Engl J Med 352:978–986

    Article  PubMed  CAS  Google Scholar 

  7. von Bueren AO, von Hoff K, Pietsch T, Gerber NU, Warmuth-Metz M, Deinlein F, Zwiener I, Faldum A, Fleischhack G, Benesch M, Krauss J, Kuehl J, Kortmann RD, Rutkowski S (2011) Treatment of young children with localized medulloblastoma by chemotherapy alone: results of the prospective, multicenter trial HIT 2000 confirming the prognostic impact of histology. Neuro Oncol 13:669–679

    Article  Google Scholar 

  8. Blaney SM, Kocak M, Gajjar A, Chintagumpala M, Merchant T, Kieran M, Pollack IF, Gururangan S, Geyer R, Phillips P, McLendon RE, Packer R, Goldman S, Banerjee A, Heideman R, Boyett JM, Kun L (2012) Pilot study of systemic and intrathecal mafosfamide followed by conformal radiation for infants with intracranial central nervous system tumors: a pediatric brain tumor consortium study (PBTC-001). J Neurooncol 109:565–571

    Article  PubMed  PubMed Central  Google Scholar 

  9. Shapiro WR, Young DF, Mehta BM (1975) Methotrexate: distribution in cerebrospinal fluid after intravenous, ventricular and lumbar injections. N Engl J Med 293:161–166

    Article  PubMed  CAS  Google Scholar 

  10. Glantz MJ, Van Horn A, Fisher R, Chamberlain MC (2010) Route of intracerebrospinal fluid chemotherapy administration and efficacy of therapy in neoplastic meningitis. Cancer 116:1947–1952

    Article  PubMed  Google Scholar 

  11. Slavc I, Schuller E, Czech T, Hainfellner JA, Seidl R, Dieckmann K (1998) Intrathecal mafosfamide therapy for pediatric brain tumors with meningeal dissemination. J Neurooncol 38:213–218

    Article  PubMed  CAS  Google Scholar 

  12. Slavc I, Schuller E, Falger J, Günes M, Pillwein K, Czech T, Dietrich W, Rössler K, Dieckmann K, Prayer D, Hainfellner J (2003) Feasibility of long-term intraventricular therapy with mafosfamide (n = 26) and etoposide (n = 11): experience in 26 children with disseminated malignant brain tumors. J Neurooncol 64:239–247

    Article  PubMed  Google Scholar 

  13. Peyrl A, Sauermann R, Traunmueller F, Azizi AA, Gruber-Olipitz M, Gupper A, Slavc I (2009) Pharmacokinetics and safety of intrathecal liposomal cytarabine in children aged <3 years. Clin Pharmacokinet 48:265–271

    Article  PubMed  CAS  Google Scholar 

  14. Peyrl A, Sauermann R, Chocholous M, Azizi AA, Jäger W, Höferl M, Slavc I (2014) Pharmacokinetics and toxicity of intrathecal liposomal cytarabine in children and adolescents following age-adapted dosing. Clin Pharmacokinet 53:165–173

    Article  PubMed  CAS  Google Scholar 

  15. Peyrl A, Chocholous M, Kieran MW, Azizi AA, Prucker C, Czech T, Dieckmann K, Schmook MT, Haberler C, Leiss U, Slavc I (2012) Antiangiogenic metronomic therapy for children with recurrent embryonal brain tumors. Pediatr Blood Cancer 59:511–517

    Article  PubMed  Google Scholar 

  16. Obbens EA, Leavens ME, Beal JW, Lee YY (1985) Ommaya reservoirs in 387 cancer patients: a 15-year experience. Neurology 35:1274–1278

    Article  PubMed  CAS  Google Scholar 

  17. Lishner M, Perrin RG, Feld R, Messner HA, Tuffnell PG, Elhakim T, Matlow A, Curtis JE (1990) Complications associated with Ommaya reservoirs in patients with cancer. The Princess Margaret Hospital experience and a review of the literature. Arch Intern Med 150:173–176

    Article  PubMed  CAS  Google Scholar 

  18. Perrin RG, Lishner M, Guha A, Curtis J, Feld R, Messner H (1990) Experience with Ommaya reservoir in 120 consecutive patients with meningeal malignancy. Can J Neurol Sci 17:190–192

    PubMed  CAS  Google Scholar 

  19. Sandberg DI, Bilsky MH, Souweidane MM, Bzdil J, Gutin PH (2000) Ommaya reservoirs for the treatment of leptomeningeal metastases. Neurosurgery 47:49–54

    PubMed  CAS  Google Scholar 

  20. Chamberlain MC, Kormanik PA, Barba D (1997) Complications associated with intraventricular chemotherapy in patients with leptomeningeal metastases. J Neurosurg 87:694–699

    Article  PubMed  CAS  Google Scholar 

  21. Takahashi M, Yamada R, Tabei Y, Nakamura O, Shinoura N (2007) Navigation-guided Ommaya reservoir placement: implications for the treatment of leptomeningeal metastases. Minim Invasive Neurosurg 50:340–345

    Article  PubMed  CAS  Google Scholar 

  22. Sampath R, Wadhwa R, Tawfik T, Nanda A, Guthikonda B (2012) Stereotactic placement of ventricular catheters: does it affect proximal malfunction rates? Stereotact Funct Neurosurg 90:97–103

    Article  PubMed  Google Scholar 

  23. Greenfield JP, Schwartz TH (2008) Catheter placement for Ommaya reservoirs with frameless surgical navigation: technical note. Stereotact Funct Neurosurg 86:101–105

    Article  PubMed  Google Scholar 

  24. Szvalb AD, Raad II, Weinberg JS, Suki D, Mayer R, Viola GM (2014) Ommaya reservoir-related infections: clinical manifestations and treatment outcomes. J Infect 68:216–224

    Article  PubMed  Google Scholar 

  25. Mead PA, Safdieh JE, Nizza P, Tuma S, Sepkowitz KA (2014) Ommaya reservoir infections: a 16-year retrospective analysis. J Infect 68:225–230

    Article  PubMed  Google Scholar 

  26. Pels H, Schmidt-Wolf IG, Glasmacher A, Schulz H, Engert A, Diehl V, Zellner A, Schackert G, Reichmann H, Kroschinsky F, Vogt-Schaden M, Egerer G, Bode U, Schaller C, Deckert M, Fimmers R, Helmstaedter C, Atasoy A, Klockgether T, Schlegel U (2003) Primary central nervous system lymphoma: results of a pilot and phase II study of systemic and intraventricular chemotherapy with deferred radiotherapy. J Clin Oncol 21:4489–4495

    Article  PubMed  CAS  Google Scholar 

  27. Pels H, Juergens A, Glasmacher A, Schulz H, Engert A, Linnebank M, Schackert G, Reichmann H, Kroschinsky F, Vogt-Schaden M, Egerer G, Bode U, Schaller C, Lamprecht M, Hau P, Deckert M, Fimmers R, Bangard C, Schmidt-Wolf IG, Schlegel U (2009) Early relapses in primary CNS lymphoma after response to polychemotherapy without intraventricular treatment: results of a phase II study. J Neurooncol 91:299–305

    Article  PubMed  CAS  Google Scholar 

  28. Stone JA, Castillo M, Mukherji SK (1999) Leukoencephalopathy complicating an Ommaya reservoir and chemotherapy. Neuroradiology 41:134–136

    Article  PubMed  CAS  Google Scholar 

  29. Obwegeser A, Seiwald M, Stockhammer G (1998) Intraventricular chemotherapy. J Neurosurg 89:172–173

    PubMed  CAS  Google Scholar 

  30. Mechleb B, Khater F, Eid A, David G, Moorman JP (2003) Late onset Ommaya reservoir infection due to Staphylococcus aureus: case report and review of Ommaya Infections. J Infect 46:196–198

    Article  PubMed  CAS  Google Scholar 

  31. Park DM, DeAngelis LM (2002) Delayed infection of the Ommaya reservoir. Neurology 59:956–957

    Article  PubMed  Google Scholar 

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Acknowledgments

This study was supported by “Forschungsgesellschaft fuer cerebrale Tumore”.

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Authors and Affiliations

  1. Department of Pediatrics, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria

    Andreas Peyrl, Monika Chocholous, Amedeo A. Azizi, Johannes Gojo, Elke Minichmayr & Irene Slavc

  2. Department of Neurosurgery, Medical University of Vienna, Vienna, Austria

    Thomas Czech & Christian Dorfer

  3. Division of Clinical Microbiology, Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria

    Dieter Mitteregger

Authors
  1. Andreas Peyrl
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  2. Monika Chocholous
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  3. Amedeo A. Azizi
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  4. Thomas Czech
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  9. Irene Slavc
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Correspondence to Irene Slavc.

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Peyrl, A., Chocholous, M., Azizi, A.A. et al. Safety of Ommaya reservoirs in children with brain tumors: a 20-year experience with 5472 intraventricular drug administrations in 98 patients. J Neurooncol 120, 139–145 (2014). https://doi.org/10.1007/s11060-014-1531-1

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  • DOI: https://doi.org/10.1007/s11060-014-1531-1

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