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Chemoport with a non-collapsible chamber as a replacement for an Ommaya reservoir in the treatment of leptomeningeal carcinomatosis

  • Clinical Article
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Abstract

Background

The Ommaya reservoir for intraventricular chemotherapy of leptomeningeal carcinomatosis (LMC) patients has been reported to have some complications. We introduced a Chemoport reservoir, with a solid non-collapsible, high-profile chamber as a the replacement for the Ommaya reservoir in LMC patients.

Objective

To evaluate the usefulness of Chemoport as an alternative to Ommaya for the intraventricular chemotherapy of LMC.

Methods

The medical records of 155 patients (89 Ommaya and 66 Chemoport) who underwent intraventricular chemotherapy via a subgaleal reservoir were reviewed. Chemoport was secured with engraving of skull.

Result

Reservoir malfunction, including one intracranial hemorrhage (ICH) under the burr hole occurred, in six patients. During the course of therapy, cerebrospinal fluid (CSF) infection was diagnosed in 19 patients and intraventricular hemorrhage with ICH was evident in three patients of the Ommaya group. Incidence of the above-mentioned complications showed no difference between the two groups. CSF leakage under a galeal flap or through a wound edge occurred more frequently in the Ommaya group (12 patients) than in the Chemoport group (two patients) and the difference was statistically significant (p = 0.03). One-hundred and four patients showed increased intracranial pressure (ICP) and 74 of them received additional CSF drainage to control increased ICP by either intermittent CSF drainage in both groups or continuous extraventricular drainage (EVD) of CSF using designated hooked needle only in the Chemoport group. Among the factors related to the control ICP, the number of chemotherapies, type of reservoir in favor of Chemoport, and EVD showed significantly improved control of ICP (p < 0.05).

Conclusion

Chemoport, as a reservoir for intraventricular chemotherapy, has superior ICP control at an equal or lower rate of complications compared with the Ommaya reservoir.

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Authors and Affiliations

  1. Neuro-Oncology Clinic, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 410-769, Republic of Korea

    Ho-Shin Gwak, Hee Seok Yang, Sang Hoon Shin, Heon Yoo & Seung Hoon Lee

  2. Cancer Biostatics Research, National Cancer Center, Goyang, Korea

    Jungnam Joo

  3. Center for Lung Cancer, National Cancer Center, Goyang, Korea

    Jin Soo Lee

  4. Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea

    Chang-Hyun Lee

Authors
  1. Ho-Shin Gwak
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  2. Chang-Hyun Lee
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  3. Hee Seok Yang
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  4. Jungnam Joo
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  5. Sang Hoon Shin
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  6. Heon Yoo
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  7. Jin Soo Lee
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  8. Seung Hoon Lee
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Corresponding author

Correspondence to Seung Hoon Lee.

Additional information

Comment

Gwak et al. bring new technical advances using the non-collapsible chamber Chemoport compared with the “classical” Ommaya reservoir for intra-ventricular chemotherapy of leptomeningeal carcinomatosis (LMC). Although the implantation of the Chemoport needs more work to enable the incorporation of the bulky reservoir into the skull by drilling the outer table, it has many advantages, especially the thick Silastic dome can be repeatedly punctured with practically no time limit. Another important new issue is the possibility to drain continuously the CSF in case of raised ICP with a special hooked needle introduced transcutaneously in the Chemoport without the risk of having the needle being inadvertently pulled and therefore obtaining the same effect as an EVD.

Benedict Rilliet

Geneva, Switzerland

Comment

Metastases of the CNS becoming increasingly common as cancer patients live longer. In multiple metastases of the brain tissue, whole brain irradiation (WBC) is often so effective in melting the lesions that patients succumb to metastases elsewhere in the body.

Leptomeningeal dissemination ('neoplastic meningitis') usually by far more devastating and resistant to the present modes of treatment with survival ranges from 8–16 weeks (1). The management requires a multidisciplinary team to palliate CNS symptoms – according to the type of primary cancer – by WBC, systemic chemotherapy, and placement of ventricular reservoirs for both intrathecal chemotherapy and alleviation of hydrocephalus by repeated punctures.

Chemoport is usually introduced into a vein for transcutaneous delivery of chemotherapy. Korean colleagues in their well-written and detailed study compared the usefulness of Chemoport (n = 66) vs Ommaya reservoir (n = 89) in intraventricular chemotherapy of leptomeningeal carcinomatosis. They conclude that Chemoport – with designated hooked needle with plastic wings that prevent slipping – is more suitable for intermittent CSF drainage that many of these pateints require. Most importanty, the Chemoport reservoir may be punctured hundreds of times without leakage that typically pesters the thinner Ommaya reservoir. The implantion reguires more bone work but the use of Chemoport reservoir should be tested and reported by other neuro-oncology teams.

Juha E Jääskeläinen

Kuopio, Finland

1. Beauchesne P. Intrathecal chemotherapy for treatment of leptomeningeal dissemination of metastatic tumours. Lancet Oncol 2010;11:871-9. Review.

This retrospective study was approved by Institutional Review Board of National Cancer Center Korea (NCCNCS-11-436).

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Gwak, HS., Lee, CH., Yang, H.S. et al. Chemoport with a non-collapsible chamber as a replacement for an Ommaya reservoir in the treatment of leptomeningeal carcinomatosis. Acta Neurochir 153, 1971–1978 (2011). https://doi.org/10.1007/s00701-011-1086-2

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  • DOI: https://doi.org/10.1007/s00701-011-1086-2

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