The use of a smartphone-assisted ventricle catheter guide for Ommaya reservoir placement—experience of a retrospective bi-center study
For intraventricular chemotherapy (IVC) as part of many oncological treatment protocols, Ommaya reservoir is enabling repeated access to the cerebro-spinal fluid (CSF). The correct placement of the catheter in the ventricle is essential for correct application of drugs, which is enabled by sophisticated techniques such as neuronavigation.
In a bi-center retrospective study, we reviewed our experience using a smartphone-assisted ventricle catheter guide as simple solution for correct Ommaya reservoir placement.
Sixty Ommaya reservoirs have been placed in 60 patients between 2011 and 2017 with the smartphone-assisted ventricular catheter guidance technique. Patient characteristics, preoperative frontal and occipital horn ratio (FOHR), postoperative catheter position, and complications were assessed.
The majority of our patients (71.6%) have got narrow or slit-like ventricles (FOHR ≤ 0.4). All Ommaya reservoirs were placed successfully. Fifty-eight ventricular catheters (97%) were inserted at the first and 2 (3%) at the second attempt using the same technique. No immediate perioperative complications were observed. All catheters (100%) could be used for IVC. Postoperative imaging was available in 52 patients. Thirty-two (61.5%) of ventricular catheters were rated as grade I, 20 (38.5%) as grade II, and none (0%) as grade III. Four patients (6.7%) showed postoperative complications during a median follow-up of 8.5 months (hydrocephalus, n = 1; infection, n = 1; parenchymal cyst around catheter, n = 1; shunt revision, n = 1).
The smartphone-assisted guide offers decent accuracy of ventricle catheter placement with ease and simplicity for a small surgical intervention. We propose this technique as routine tool for Ommaya reservoir placement independent of lateral ventricular size to decrease the rate of ventricle catheter malposition as reasonable alternative to a neuronavigation system.
KeywordsOmmaya reservoir Ventricular access device (VAD) Intrathecal chemotherapy (IVC) Ventricular catheter Neuronavigation Stereotaxy Thomale guide
Compliance with ethical standards
Conflict of interest
UWT holds a patent on the guiding instrument. UWT and AS received lecture honorarium from Miethke Aesculap Comp. in the past. All other authors have no conflict of interest to declare.
- 6.Morgenstern PF, Connors S, Reiner AS, Greenfield JP (2016) Image guidance for placement of Ommaya reservoirs: comparison of fluoroscopy and frameless stereotactic navigation in 145 patients. World Neurosurg 93:154–158. https://doi.org/10.1016/j.wneu.2016.04.090 CrossRefPubMedPubMedCentralGoogle Scholar
- 9.Weiner GM, Chivukula S, Chen CJ, Ding D, Engh JA, Amankulor N (2015) Ommaya reservoir with ventricular catheter placement for chemotherapy with frameless and pinless electromagnetic surgical neuronavigation. Clin Neurol Neurosurg 130:61–66. https://doi.org/10.1016/j.clineuro.2014.12.018 CrossRefPubMedGoogle Scholar
- 11.Yim B, Reid Gooch M, Dalfino JC, Adamo MA, Kenning TJ (2016) Optimizing ventriculoperitoneal shunt placement in the treatment of idiopathic intracranial hypertension: an analysis of neuroendoscopy, frameless stereotaxy, and intraoperative CT. Neurosurg Focus 40(3):E12. https://doi.org/10.3171/2015.12.FOCUS15583 CrossRefPubMedGoogle Scholar
- 14.Thomale U-W, Schaumann A, Stockhammer F, Giese H, Schuster D, Kästner S, Ahmadi AS, Polemikos M, Bock H-C, Gölz L, Lemcke J, Hermann E, Schuhmann MU, Beez T, Fritsch M, Orakcioglu B, Vajkoczy P, Rohde V, Bohner G (2017) GAVCA study: randomized, multicenter trial to evaluate the quality of ventricular catheter placement with a mobile health assisted guidance Technique. Neurosurgery. https://doi.org/10.1093/neuros/nyx420
- 16.Huyette DR, Turnbow BJ, Kaufman C, Vaslow DF, Whiting BB, MY O (2008) Accuracy of the freehand pass technique for ventriculostomy catheter placement: retrospective assessment using computed tomography scans. J Neurosurg 108(1):88–91. https://doi.org/10.3171/JNS/2008/108/01/0088 CrossRefPubMedGoogle Scholar
- 19.Hayhurst C, Beems T, Jenkinson MD, Byrne P, Clark S, Kandasamy J, Goodden J, Nandoe Tewarie RD, Mallucci CL (2010) Effect of electromagnetic-navigated shunt placement on failure rates: a prospective multicenter study. J Neurosurg 113(6):1273–1278. https://doi.org/10.3171/2010.3.JNS091237 CrossRefPubMedGoogle Scholar
- 21.Whitehead WE, Riva-Cambrin J, Wellons JC 3rd, Kulkarni AV, Browd S, Limbrick D, Rozzelle C, Tamber MS, Simon TD, Shannon CN, Holubkov R, Oakes WJ, Luerssen TG, Walker ML, Drake JM, Kestle JR, for the Hydrocephalus Clinical Research N (2014) Factors associated with ventricular catheter movement and inaccurate catheter location: post hoc analysis of the hydrocephalus clinical research network ultrasound-guided shunt placement study. J Neurosurg Pediatr 14(2):173–178. https://doi.org/10.3171/2014.5.PEDS13481 CrossRefPubMedGoogle Scholar
- 22.Whitehead WE, Riva-Cambrin J, Wellons JC 3rd, Kulkarni AV, Holubkov R, Illner A, Oakes WJ, Luerssen TG, Walker ML, Drake JM, Kestle JR, Hydrocephalus Clinical Research N (2013) No significant improvement in the rate of accurate ventricular catheter location using ultrasound-guided CSF shunt insertion: a prospective, controlled study by the Hydrocephalus Clinical Research Network. J Neurosurg Pediatr 12(6):565–574. https://doi.org/10.3171/2013.9.PEDS1346 CrossRefPubMedGoogle Scholar
- 25.Schaumann A, Thomale UW (2013) Guided application of ventricular catheters (GAVCA)—multicentre study to compare the ventricular catheter position after use of a catheter guide versus freehand application: study protocol for a randomised trail. Trials 14(1):428. https://doi.org/10.1186/1745-6215-14-428 CrossRefPubMedPubMedCentralGoogle Scholar
- 27.Peyrl A, Chocholous M, Azizi AA, Czech T, Dorfer C, Mitteregger D, Gojo J, Minichmayr E, Slavc I (2014) Safety of Ommaya reservoirs in children with brain tumors: a 20-year experience with 5472 intraventricular drug administrations in 98 patients. J Neuro-Oncol 120(1):139–145. https://doi.org/10.1007/s11060-014-1531-1 CrossRefGoogle Scholar