Ommaya Reservoir

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Schematic representation of an Ommaya reservoir

An Ommaya reservoir or Rickham reservoir is a catheter system that is used primarily for the locoregional chemotherapy of brain tumors and is implanted in the ventricular system of the brain .

Surname

The Ommaya Reservoir is named after the Pakistani neurosurgeon Ayub Khan Ommaya (1930-2008), who invented it in 1963.

Application and structure

An Ommaya or Rickham reservoir is mainly used for the therapy of brain tumors . Those on the reservoir , a cytostatic drug in the cerebrospinal fluid ( "cerebrospinal fluid") cast ( intrathecal ). This procedure bypasses the blood-brain barrier , as it prevents many systemically administered active substances from being transported to the brain. It can also be implanted for pain syndromes with central spasticity . Another area of use is found in the newborn medicine when in small premature infants , for example, after a cerebral hemorrhage the cerebrospinal fluid reabsorption is disrupted and a discharge line for preventing the water head is necessary. Since the installation of a permanent drain with a shunt system is only possible from a certain weight and under certain conditions, an external drain with a reservoir is used to bridge the gap, which can regularly be punctured from the outside.

Sectional drawing of a Rickham Reservoir
Rickham Reservoir implanted in the ventricular system of the brain.

The Ommaya reservoir consists of a small, pillow-shaped plastic container that lies under the scalp (subgaleal). The reservoir is implanted under the scalp in a short neurosurgical operation so that the catheter can be placed in the anterior horn of the lateral ventricle of the non-dominant hemisphere . A thin tube, the ventricular catheter , which is connected to the reservoir, extends into a cavity (a ventricle) filled with liquor . The reservoir can be pierced using a thin cannula . On the one hand, fluid can be removed from the operating cavity - for diagnostic purposes , for example - ( liquor puncture ), and on the other hand, active substances or diagnostic agents can be applied to the ventricle. The Rickham Reservoir, unlike the Ommaya Reservoir, has a metal bottom.

During implantation, there is a low risk of bleeding and an infection risk of up to 20%, as well as a general risk of anesthesia .

literature

  • B. Mechleb et al. a .: Late onset Ommaya reservoir infection due to Staphylococcus aureus: case report and review of Ommaya infections. In: J Infect. 46, 2003, pp. 196-198. PMID 12643873 (review article).
  • MB Kosier and P. Minkler: Nursing management of patients with an implanted Ommaya reservoir. In: Clin J Oncol Nurs. 3, 1999, pp. 63-67. PMID 10633613 (review article).
  • T. Uejima and S. Suresh: Ommaya and McComb reservoir placement in infants: can this be done with regional anesthesia? In: Pediatr Anaesth. 18, 2008, pp. 909-911. PMID 18482244 .
  • M. Takahashi et al. a .: Navigation-guided Ommaya reservoir placement: implications for the treatment of leptomeningeal metastases. In: Minim Invasive Neurosurg. 50, 2007, pp. 340-345. PMID 18210356 .
  • P. Peretta et al. a .: The role of Ommaya reservoir and endoscopic third ventriculostomy in the management of post-hemorrhagic hydrocephalus of prematurity. In: Childs Nerv Syst. 23, 2007, pp. 765-771. PMID 17226031 .
  • RD Dickerman and MB Eisenberg: Preassembled method for insertion of Ommaya reservoir. In: Journal of Surgical Oncology . 89, 2005, pp. 36-38. PMID 15611937 .

Individual evidence

  1. ↑ U. Zettl and a .: Clinical CSF diagnostics. Verlag Walter de Gruyter, 2005, ISBN 3-11-018169-X , p. 28.
  2. ^ A b P. Berlit: Therapielexikon Neurologie. Verlag Springer, 2005, ISBN 3-540-67137-4 , p. 939.
  3. ↑ U. Schlegel u. a .: Combined systemic and intraventricular chemotherapy in primary CNS lymphoma: a pilot study. In: J Neurol Neurosurg Psychiatry. 71, 2001, pp. 118-122. PMID 11413277