Ommaya reservoir (OR)

Supine on surgical table.

Head in neutral position.

Neuro Navigation.

Kocher's point is used for access to the frontal horn of the lateral ventricle.

The trajectory for entry into the frontal horn of the lateral ventricle is toward the intersection of the medial canthus and tragus.

A semi-circular incision is made in the right frontal area.

A curvilinear incision was made in the right frontal region to expose Kocher's point.

A burr hole is placed at Kocher's point.

With stereotactic navigation, the ventricular catheter is inserted to a pre-measured depth of approximately 5.5 - 6 cm from the cortex.

The catheter is truncated and attached to the Ommaya reservoir.

The reservoir is placed posterior to the burr hole in a subgaleal pocket.

The incision is closed in layers.

The skin is closed with a running absorbable monofilament suture and sealed with Dermabond.

Post Op

CT head performed post-operatively confirmed proper placement of ventricular catheter in the right frontal horn with the tip at the foramen of Monro.

A total of 20 patients with a median age of 3.3 years at VCSR implantation received 31 VCSR. Overall, 19 complications in 11 patients were recorded: 7 patients had a VCSR-related infection with coagulase-negative staphylococci, 4 of these probably as a surgical complication and 3 probably related to VCSR use. Systemic perioperative prophylaxis was administered in 22 cases, and intraventricular vancomycin and gentamicin were given in 8 cases (none of which subsequently developed an infection). Other complications included wound dehiscence, catheter malplacement, and leakage of cerebrospinal fluid. Overall, 17 VCSR were explanted due to complications. Conclusion Infections were the most frequent VCSR-related complication. In our own institution, the high rate of complications led to the definition of a bundle of measures as a standard operating procedure for VCSR placement and use. Prospective studies in larger patient collectives are warranted to better identify risk factors and evaluate preventive measures such as the administration of perioperative antibiotics and the use of antimicrobial coating of catheters 1).

Among 501 OR placements, 40 patients (8%) developed an Ommaya reservoir-related infections ORRI. These presented with meningitis and/or meningoencephalitis (60%), cellulitis (20%), or a combination thereof (20%). Approximately 40% occurred ≤30 days of OR placement, while 60% occurred ≤10 days after the device was last accessed. Only 20% presented with leukocytosis, while another 18% had a normal cerebrospinal fluid (CSF). Gram-positive skin flora accounted >80% of the pathogens. The median hospital stay and duration of antibiotics were 13 and 24 days, respectively. Although mortality rates (≈10%) were similar among all treatment groups (p > 0.99), shorter hospitalization and antimicrobial treatment durations were obtained with early versus late device removal (p < 0.038). As clinical symptoms can be non-specific and CSF parameters may be within normal limits, a high suspicion for infection is required. The shortest hospitalization and treatment course was achieved with early device removal 2).

Gerber NU, Müller A, Bellut D, Bozinov O, Berger C, Grotzer MA. Ventricular Catheter Systems with Subcutaneous Reservoirs (Ommaya Reservoirs) in Pediatric Patients with Brain Tumors: Infections and Other Complications. Neuropediatrics. 2015 Oct 19. [Epub ahead of print] PubMed PMID: 26479760.
Szvalb AD, Raad II, Weinberg JS, Suki D, Mayer R, Viola GM. Ommaya reservoir-related infections: Clinical manifestations and treatment outcomes. J Infect. 2013 Dec 17. pii: S0163-4453(13)00378-2. doi: 10.1016/j.jinf.2013.12.002. [Epub ahead of print] PubMed PMID: 24360921.
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  • Last modified: 2022/12/02 10:58
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