Ommaya reservoir
The Ommaya reservoir is a medical device surgically implanted under the scalp, designed for the direct administration of drugs into the cerebrospinal fluid (CSF). This device is particularly useful for patients with brain cancers, metastases, and certain solid tumor leptomeningeal diseases, as it allows medications like chemotherapy, antibiotics, or monoclonal antibodies to bypass the blood-brain barrier and effectively target cancer cells. The surgical procedure involves the insertion of a small dome-shaped reservoir connected to a catheter, which is placed under general anesthesia and guided into the brain's ventricles using stereotactic navigation.
Following placement, the Ommaya reservoir can be accessed by healthcare professionals for drug delivery or CSF sampling. The procedure is generally quick, often completed within forty minutes, and patients may be discharged on the same day. While the Ommaya reservoir offers numerous benefits, including reduced pain and improved drug efficacy, it does carry some risks, such as infection and tube blockage. Patients are advised to monitor for any unusual symptoms post-procedure, ensuring timely medical intervention if needed. Overall, the Ommaya reservoir serves as an effective tool in the management of certain neurological conditions, allowing for targeted treatment approaches.
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Subject Terms
Ommaya reservoir
ALSO KNOWN AS: Implanted intrathecal device, intraventricular device
DEFINITION: An Ommaya reservoir is a device surgically placed under the scalp that allows the administration of drugs, such as chemotherapy, antibiotics, or monoclonal antibodies, directly into the cerebrospinal fluid (CSF), bypassing the blood-brain barrier. It may also be used to sample CSF.
Cancers treated:Brain and related nervous system cancers, any brain metastasis, and solid tumor leptomeningeal diseases (LMDs) like breast cancer, lung cancer, and melanoma.
Why performed: Blood vessels that provide blood to the brain filter out drugs and other substances, preventing them from reaching the brain and CSF. This also blocks from reaching cancer cells in the brain and CSF. With the surgical placement of an Ommaya reservoir, drugs may be delivered directly to brain tumors or metastases. In some cases, the Ommaya reservoir has been used to drain cystic lesions in the brain.
Patient preparation: Imaging tests, such as computed tomography (CT) scans, are used before surgery to ensure proper placement. The Ommaya reservoira small plastic, dome-shaped device with an attached tubeis placed by a neurosurgeon under general anesthesia.
Steps of the procedure: An area of the head is shaved, and a C-shaped incision is made in the skin. The tube, or catheter, is inserted through a hole drilled in the skull. The incision site is intentionally large because the nerves that send pain messages to the brain near the dome are severed, allowing the Ommaya reservoir to be painless. Using a stereotactic navigation system, the surgeon threads the tube into the hollow space, or ventricle, which holds CSF. The procedure typically takes less than forty minutes, and most patients are released from the hospital the same day.
After the procedure: A CT scan is taken to ensure the proper placement of the Ommaya reservoir. The wound heals in ten to fourteen days. After the surgical site heals, a physician or specially trained nurse may access the device to remove CSF or administer chemotherapy, antibiotics, or monoclonal antibodies. The medical professional cleanses the skin over the device and uses a sterile needle to pierce the dome. A small amount of CSF is removed, called the Ommaya reservoir tap, and sent out for testing, and the drugs are administered. The needle is withdrawn, and pressure is applied to the needle site to control bleeding. Patients can go home between treatments with the device in place and continue normal activities.
The patient should report symptoms such as headache, unusual sleepiness, stiff neck, nausea, and vomiting immediately. The doctor can adjust the amount of fluid taken in each sample or prescribe a steroid to control these symptoms.
Risks: The risks associated with an Ommaya reservoir are generally related to tube blockage or infection. It is important to observe the area for signs of infection, such as redness and warmth at the needle site. Any usual side effects of chemotherapy administration may occur. Other risks include bleeding, blood clots, and wrong location placement.
Results: The patient may expect chemotherapy and other drugs to reach the necessary site of action with minimum pain.
Bibliography
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