Summary
Ten patients with implanted Ommaya devices developed pericatheter white matter lesions, apparent as focal lucenaries on computed tomographic scan sometimes with contrast enhancement and/or mass effect. Some of the patients had significant neurological signs that related to the lesion. Three of the patients had not received cytotoxic drugs through the reservoir, and two had received neither intrathecal chemotherapy nor cranial radiation therapy. The process appears to be related to back flow of cerebrospinal fluid, with or without contained cytotoxic drugs into the periventricular white matter. Patients with elevated intracranial pressure are at particular risk. Removal of the catheter relieves the condition.
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References
Ommaya AK: Subcutaneous reservoir and pump for sterile access to ventricular cerebrospinal fluid. Lancet 2:983–984, 1963
Ratcheson RA, Ommaya AK: Experience with the subcutaneous cerebrospinal fluid reservoir. N Engl J Med 279:1025–1031, 1968
Salmon JH: Adult hydrocephalus: evaluation of shunt therapy in 80 patients. J Neurosurg 37:423–428, 1972
Shapiro WR, Chernik NL, Posner JB: Necrotizing encephalopathy following intraventricular instillation of methotrexate. Arch Neurol 28:96–102, 1973
Norrell H, Wilson CB, Slagel DE, Clark DB: Leukoencephalopathy following the administration of methotrexate into the cerebrospinal fluid in the treatment of primary brain tumors. Cancer 33:923–932, 1974
Bleyer WA, Pizzo PA, Spence AM, Platt WD, Benjamin DR, Kolins J et al.: The Ommaya reservoir: newly recognized complications and recommendations for insertion and use. Cancer 41:2431–2437, 1978
Packer RJ, Zimmerman RA, Rosenstock J, Rorke LB, Norris DG, Berman PH: Focal encephalopathy following methotrexate therapy: Administration via a misplaced intraventricular catheter. Arch Neurol 38:450–452, 1981
Robain O, Dulac O, Dommergues JP, Bernaudin F, Diebler K, Kalifa C, et al.: Necrotizing leukoencephalopathy complicating treatment of childhood leukemia. J Neurol Neurosurg Psychiatry 47:65–72, 1984
Obbens EAMT, Leavens ME, Beal JW, Lee YY: Ommaya reservoirs in 387 cancer patients: A 15-year experience. Neurology 35:1274–1278, 1985
Chiba Y, Takagi H, Nakajima F, Fujii S, Kitahara T, Yagishita S, et al.: Cerebrospinal fluid edema: a rare complication of shunt operations for hydrocephalus, report of three cases. J Neurosurg 57:697–700, 1982
Hockley AD: Histological response to ventricular catheters. Monogr neural sci 8:63–65, 1982
Weller RO, Williams BN: Cerebral biopsy and assessment of brain damage in hydrocephalus. Arch Dis Chil 50:763–768, 1975
Grossman SA, Trump DL, Chen DCP, Thompson G, Camargo EE: Cerebrospinal fluid flow abnormalities in patients with neoplastic meningitis: an evaluation using IIIIndium-DPTA ventriculography. Am J Med 73:641–647, 1982
Page L: The relationship between cerebrospinal fluid and brain extracellular fluid in normal and hydrocephalic dogs. In: Shapiro K, Marmarou A, Portnoy H (eds) Hydrocephalus. New York, NY, Raven Press 1984, 109–120
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Lemann, W., Wiley, R.G. & Posner, J.B. Leukoencephalopathy complicating intraventricular Catheters: clinical, radiographic and pathologic study of 10 cases. J Neuro-Oncol 6, 67–74 (1988). https://doi.org/10.1007/BF00163543
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DOI: https://doi.org/10.1007/BF00163543