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Real-Time Fluoroscopic and C-Arm Computed Tomography Evaluation of Ommaya Reservoir Integrity

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ABSTRACT

We describe a case of a 24-year-old patient with relapsed acute myelogenous leukemia involving the central nervous system. After placement of an Ommaya reservoir for intrathecal chemotherapy administration, the patient developed progressive headache, nausea, and drowsiness and was found to have an enlarging subdural collection underlying the Ommaya. To exclude leakage of the Ommaya system into the subdural space, real-time fluoroscopic and C-arm computed tomographic evaluation of the Ommaya reservoir was performed after iodinated contrast injection into the reservoir. This novel technique demonstrated complete integrity of the Ommaya reservoir without evidence of blockage or leakage of the system. The patient underwent uncomplicated evacuation of the subdural collection without replacement of the Ommaya reservoir and made an excellent recovery. This technique for real-time interrogation of the Ommaya reservoir may have additional utility in the evaluation for Ommaya reservoir dysfunction.

No MeSH data available.


Head computed tomography images before and after Ommaya reservoir placement demonstrate increasing size of a right subdural collection. Axial (A-C) and coronal reformations (D-F) from a non-contrast head computed tomogram demonstrate a normal appearance of the brain prior to Ommaya reservoir placement (A, D). After Ommaya reservoir placement, the catheter (B, C, E, F, arrowheads) traverses the right frontal lobe (B, C) and terminates in the right lateral ventricle near the foramen of Monro (E, F). There is a hypodense subdural collection (B, C, E, R, arrows) overlying the right frontal lobe that was initially small (B, E) but increased on a follow-up study (C, F).
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FIG2: Head computed tomography images before and after Ommaya reservoir placement demonstrate increasing size of a right subdural collection. Axial (A-C) and coronal reformations (D-F) from a non-contrast head computed tomogram demonstrate a normal appearance of the brain prior to Ommaya reservoir placement (A, D). After Ommaya reservoir placement, the catheter (B, C, E, F, arrowheads) traverses the right frontal lobe (B, C) and terminates in the right lateral ventricle near the foramen of Monro (E, F). There is a hypodense subdural collection (B, C, E, R, arrows) overlying the right frontal lobe that was initially small (B, E) but increased on a follow-up study (C, F).

Mentions: The patient developed a headache seven days after placement of the Ommaya reservoir, and there was difficulty in accessing the Ommaya. A head CT demonstrated appropriate positioning of the Ommaya reservoir tip in the frontal horn of the right lateral ventricle, but a new hypodense 5-mm extra-axial collection overlying the right frontal lobe was present (Figure 2). The patient’s headache worsened, and he developed nausea and vomiting with intrathecal chemotherapy administration. A follow-up head CT demonstrated an interval increase in the size of the right frontal extra-axial collection with an associated increase in local mass effect on the adjacent cerebral sulci and modest midline shift.


Real-Time Fluoroscopic and C-Arm Computed Tomography Evaluation of Ommaya Reservoir Integrity
Head computed tomography images before and after Ommaya reservoir placement demonstrate increasing size of a right subdural collection. Axial (A-C) and coronal reformations (D-F) from a non-contrast head computed tomogram demonstrate a normal appearance of the brain prior to Ommaya reservoir placement (A, D). After Ommaya reservoir placement, the catheter (B, C, E, F, arrowheads) traverses the right frontal lobe (B, C) and terminates in the right lateral ventricle near the foramen of Monro (E, F). There is a hypodense subdural collection (B, C, E, R, arrows) overlying the right frontal lobe that was initially small (B, E) but increased on a follow-up study (C, F).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5392038&req=5

FIG2: Head computed tomography images before and after Ommaya reservoir placement demonstrate increasing size of a right subdural collection. Axial (A-C) and coronal reformations (D-F) from a non-contrast head computed tomogram demonstrate a normal appearance of the brain prior to Ommaya reservoir placement (A, D). After Ommaya reservoir placement, the catheter (B, C, E, F, arrowheads) traverses the right frontal lobe (B, C) and terminates in the right lateral ventricle near the foramen of Monro (E, F). There is a hypodense subdural collection (B, C, E, R, arrows) overlying the right frontal lobe that was initially small (B, E) but increased on a follow-up study (C, F).
Mentions: The patient developed a headache seven days after placement of the Ommaya reservoir, and there was difficulty in accessing the Ommaya. A head CT demonstrated appropriate positioning of the Ommaya reservoir tip in the frontal horn of the right lateral ventricle, but a new hypodense 5-mm extra-axial collection overlying the right frontal lobe was present (Figure 2). The patient’s headache worsened, and he developed nausea and vomiting with intrathecal chemotherapy administration. A follow-up head CT demonstrated an interval increase in the size of the right frontal extra-axial collection with an associated increase in local mass effect on the adjacent cerebral sulci and modest midline shift.

View Article: PubMed Central - HTML - PubMed

ABSTRACT

We describe a case of a 24-year-old patient with relapsed acute myelogenous leukemia involving the central nervous system. After placement of an Ommaya reservoir for intrathecal chemotherapy administration, the patient developed progressive headache, nausea, and drowsiness and was found to have an enlarging subdural collection underlying the Ommaya. To exclude leakage of the Ommaya system into the subdural space, real-time fluoroscopic and C-arm computed tomographic evaluation of the Ommaya reservoir was performed after iodinated contrast injection into the reservoir. This novel technique demonstrated complete integrity of the Ommaya reservoir without evidence of blockage or leakage of the system. The patient underwent uncomplicated evacuation of the subdural collection without replacement of the Ommaya reservoir and made an excellent recovery. This technique for real-time interrogation of the Ommaya reservoir may have additional utility in the evaluation for Ommaya reservoir dysfunction.

No MeSH data available.