Intrathecal delivery of nusinersen using the Ommaya reservoir in a spinal muscular atrophy type 2 patient: a case report / 中华神经科杂志

Ommaya reservoir implantation is generally used in the treatment of hydrocephalus and intraventricular drug administration. Ommaya reservoir implantation in the subarachnoid space of the spinal cord for the intrathecal drug administration has not been carried out in China, and only several reports can be retrieved from PubMed. About 60%-90% of untreated patients with spinal muscular atrophy type 2 (SMA2) who survive to adulthood often have complex scoliosis and joint deformities. Nusinersen is an effective drug for the treatment of SMA2. And the route of administration is intrathecal injection, which is difficult for patients with severe scoliosis. This article summarizes the process of Ommaya reservoir implantation and postoperative drug administration in a patient with complex scoliosis type SMA2, which provides a new method for clinical treatment of this disease.

Use of Ommaya Reservoirs to Deliver Pemetrexed in Leptomeningeal Metastasis from Non-small Cell Lung Cancer: A Case Report and Review of the Literature / 中国肺癌杂志

Leptomeningeal metastasis (LM) is one of the most severe complications of non-small-cell lung cancer (NSCLC), and its incidence is increasing gradually with the progress of targeted therapies. There are currently no standard guidelines for the therapy of LM. Intrathecal chemotherapy is the mainstay of treatment for NSCLC patients with LM, but the optimal drug, administration route and mode, and dosage remain unclear. We report a case of LM from NSCLC, who received the intrathecal chemotherapy with pemetrexed by Ommaya reservoir after prior targeted therapies. This local treatment improved the quality of life, and obtained the clearing of CSF cytology and stable lesions of LM without any notable side effects. After confirmation of LM, the patient has survived 17 months until now. Here we report the first case to demonstrate the potential effectiveness of intrathecal pemetrexed by Ommaya reservoir for the treatment of LM of NSCLC, summarize the safety and effectiveness of intrathecal chemotherapy in combination with related literatures, and provide a new strategy for local treatment of LM in clinical.
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A Case of Recurrent Meningitis Caused by Rhodococcus species Successfully Treated with Antibiotic Treatment and Intrathecal Injection of Vancomycin through an Ommaya Reservoir / 감염과화학요법

Human infection by Rhodococcus species is rare and mostly limited to immunocompromised hosts such as patients infected with the human immunodeficiency virus (HIV) or organ transplant recipients. The most common strain is R. equi, and the most common clinical presentation is pulmonary infection, reported in 80% of Rhodococcus spp. infections. The central nervous system is an uncommon infection site. We report a case of a patient with pneumonia, brain abscess, and recurrent meningitis caused by Rhodococcus spp. He initially presented with pneumonia with necrosis, which progressed to brain abscess and recurrent meningitis. Rhodococcus spp. was identified from the cerobrospinal fluid (CSF) collected during his fourth hospital admission. Despite prolonged treatment with appropriate antibiotics, meningitis recurred three times. Finally, in order to administer antibiotics directly into the CSF and bypass the blood-brain barrier, an Ommaya reservoir was inserted for administration of 90 days of intrathecal vancomycin and amikacin in conjunction with intravenous and oral antibiotics; the patient was finally cured with this treatment regimen.

Carcinomatosis meníngea: presentación de un caso y revisión del tema / Meningeal carcinomatosis: case report and review of the topic

La carcinomatosis meníngea (CM) es una diseminación difusa de células tumorales en el interior del líquido cefalorraquídeo (LCR) y/o las leptomeninges con siembras difusas de tumores metastásicos sobre ellas. Esta enfermedad ocurre en aproximadamenteel 8 por ciento de las neoplasias malignas. En este trabajo se hace referencia a una paciente femenina pre-escolar de 4 años de edad, debutó con una cefalea bifrontal matutina y ocasionales, acompañadas de vómitos que se hicieron cada vez más frecuentes y que la llevaron a la pérdida de peso progresivo, luego se acompañaba de ataxia troncular, en una RMN se evidenció una lesión tumoral de la fosa posterior, que producía hidrocefalia triventricular, fue intervenida quirúrgicamente donde se realizó exéresis total del tumor. La paciente tuvo una evolución postquirúrgica inmediata favorable, pero luego presentó múltiples complicaciones, luego de mejorar se vuelve a estudiar con RMN donde se mostró un engrosamiento difuso de las meninges que por biopsia se confirmó una invasión leptomeningea del tumor primario operado.

Cystic craniopharyngioma: intratumoral chemotherapy with alpha interferon / Craniofaringioma cístico: quimioterapia intratumoral com interferon alfa

OBJECTIVE: To assess whether the cystic craniopharyngiomas can be controlled with the use of intratumoral applications of interferon alpha. METHOD: Nineteen patients with the diagnosis of cystic craniopharyngioma were treated with intratumoral chemotherapy with interferon alpha from January 2002 to April 2006. All patients underwent placement of an intracystic catheter connected to an Ommaya reservoir. Through this reservoir were made applications during chemotherapy cycles. Each cycle corresponded to application of 3,000,000 units of interferon alpha three times per week on alternate days totalizing 36,000,000 units. Response to treatment was evaluated by calculating the tumor volume on MRI control after one, three and six months after the end of each cycle. Patients who developed worsening of symptoms or who had insignificant reduction in tumor volume during follow-up underwent repeat cycle chemotherapy. RESULTS: Four patients received four cycles of chemotherapy, three patients received three cycles, six patients received two cycles and six patients received one. The lower percentage of reduction in tumor volume was 60 percent and the bigger reduction was 98.37 percent. Eleven patients had a reduction greater than 90 percent. Five patients had a tumor reduction between 75 and 90 percent and in three patients the tumors were reduced by less than 75 percent. No deaths occurred during treatment and side effects of interferon alpha were well tolerated. No treatment was discontinued. Follow-up after the last application ranged from one year and five months to three years and nine months. CONCLUSION: The intratumoral chemotherapy with interferon alpha decreases the volume of cystic craniopharyngiomas and so far can be considered a new therapeutic alternative.

OBJETIVO: Avaliar se os craniofaringiomas císticos podem ser controlados com aplicações intratumorais de interferon alfa. MÉTODO: De janeiro de 2002 a abril de 2006, 19 pacientes foram submetidos à colocação de um cateter intracístico conectado a reservatório de Ommaya para aplicações intratumorais de ciclos de 36.000.000 de unidades de interferon alfa. A resposta ao tratamento foi avaliada pelo cálculo do volume tumoral na ressonância magnética de controle ao término de cada ciclo. RESULTADOS: Os pacientes receberam de um a quatro ciclos de quimioterapia. Onze pacientes apresentaram uma redução do volume tumoral maior que 90 por cento; cinco pacientes apresentaram uma redução entre 75 por cento e 90 por cento e três pacientes uma redução menor de 75 por cento. Não houve óbitos durante o tratamento e os efeitos colaterais do inferferon alfa foram bem tolerados. Nenhum tratamento foi interrompido. CONCLUSÃO: A quimioterapia intratumoral com interferon alfa diminui o volume dos craniofaringeomas císticos e pode ser considerada uma nova alternativa terapêutica.

The clinical analysis of three methods in the treatment of intracranial bacterial infection / 西安交通大学学报·英文版

Objective: To analyze the effect of three therapeutic methods to find an optimal approach to the treatment of intracranial bacterial infection by retrospectively reviewing 33 intracranial bacterial infection patients who were admitted from 1995 to 2008 in our hospital. Methods: The treatments by intermittent lumbar puncture, continuous lumbar subarachnoid space drainage, and embedment of Ommaya cyst for continuous drainage from the ventricles were performed in 15 cases, 12 cases, and 6 cases respectively along with intravenous application of full dose of antibiotics. Results: Nineteen cases were cured and the best prognosis was from the group of Ommaya cyst embedment and continuous drainage from the ventricles. Conclusion: Management goals are prompt recognition of the central nervous system (CNS) infection, rapid identification of causative organisms and initiation of treatment with the optimal management methods for complications. Embedment of Ommaya cyst for continuous drainage from the ventricle is a safe and effective treatment for intracranial bacterial infection.

The clinical analysis of three methods in the treatment of intracranial bacterial infection / 药物分析学报

Objective To analyze the effect of three therapeutic methods to find an optimal approach to the treatment of intracranial bacterial infection by retrospectively reviewing 33 intracranial bacterial infection patients who were admitted from 1995 to 2008 in oar hospital. Methods The treatments by intermittent lumbar puncture,continuous lumbar subarachnoid space drainage, and embedment of Ommaya cyst for continuous drainage from the ventricles were performed in 15 cases, 12 cases, and 6 cases respectively along with intravenous application of full dose of antibiotics. Results Nineteen cases were cured and the best prognosis was from the group of Ommaya cyst embedment and continuous drainage from the ventricles. Conclusion Management goals are prompt recognition of the central nervous system (CNS) infection, rapid identification of causative organisms and initiation of treatment with the optimal management methods for complications. Embedment of Ommaya cyst for continuous drainage from the ventricle is a safe and effective treatment for intracranial bacterial infection.

Management of Posthemorrhagic Hydrocephalus in an Extremely Low Birth Weight Infant with an Ommaya reservoir: A Case Report

Posthemorrhagic hydrocephalus is a major problem in premature infants. We describe our experience with a neonate that was an extremely low birth weight infant with posthemorrhagic hydrocephalus, who was treated by repeated ventricular drainage through an Ommaya reservoir for more than two months until the placement of a ventriculoperitoneal shunt was possible. The Ommaya reservoir served as a bridge to definitive treatment. The patient required sodium supplements due to excessive salt loss from the repeated ventricular drainage procedures. Regular measurement of serum electrolytes in any infant requiring serial ventricular drainage is recommended.

Using of Ommaya reservoir in postoperative intracranial infection combined with hydrocephalus in patients with severe traumatic brain injury / 中国医师进修杂志

Objective To investigate the treatment function and dominance of Ommaya reservoir,which was used to treat postoperative intracranial infection combined with hydrocephalus in patients with severe traumatic brain injury. Methods Thirty-four patients suffered intracranial infection combined with hydrocephalus after operations. They were randondy divided into 2 groups.Thirleen patients were treated with Ommaya reservoir, the others were treated with external ventricular drainage. The 24-hour mean drain quantum, the mean days from implantation pumps or htbes to ventriculo-peritoneal (V-P) shunt operation,the rate of secondary operation and the rate of getting V-P shunt operation were analyzed, then the Glasgow outcome scale ( GOS ) of patients were observed at 3 months. Results Compared with patients treated with external ventriular drainage, patients with Ommaya reservoir had the less24-hour mean drain quantum and shorten time to get the V-P shunt operation,the mean days from implantation pumps to get V-P shunl was(57.00 ± 8.06) days. In 13 patients with Ommaya reservoir, 10 patients finished V-P shunt operation finally,3 patients gave up the shunt operation, shunt rate was 76.9%.In the treatment period , 4 patients had to change the Ommaya reservoir, secondary operation rate was 30.8%. Thirteen patients had the chance to get V-P shunt operation among 21 patients which got external ventricular drainage, 3 patients gave up the shunt operation, 5 patients died, shunt rate was 61.9%, 16 patients changed the ventricular drainage tube, sec-ondary operation rate was 76.2%. There was no significant difference in 3-month GOS between them (P ＞0.05 ). Conclusions Compared with external ventricular drainage, Ommaya reservoir has similar shunt rate.Ommaya reservoir has the less secondary operation rale, shorten the treatment days postoperative intracranial infection combined with hydrocephalus in patients with severe traumatic brain injury, so it should be popularized in clinic.

Huge Cyst Formation after Gamma Knife Radiosurgery for Arteriovenous Malformation: A Case Report

Radiosurgery is effective in obliterating cerebral arteriovenous malformation(AVM), and delayed cyst formation after radiosurgery is very rare. An 18-year-old man underwent Gamma Knife radiosurgery for arteriovenous malformation located in the left frontotemporal area, which had manifested with hemorrhaging. The 15,01cm3 nidus was covered with a 50% isodose volume. A central dose of 50Gy was used to obtain a marginal dose of 25Gy. One year later, he developed headache and right hemiparesis. MRI showed a huge, multilobulated cyst around the AVM. Follow-up cerebral angiography showed partial obliteration of the AVM nidus. Removal of cystic fluid(about 70cc) was done by stereotactic method, which was revealed as translucent, xanthochromic but had no tumor cell. Two months later, reaccumulation of the cyst was seen on the follow-up MRI insertion setting of Ommaya reservoir was performed. For the diagnosis of complications after radiosurgery for AVM, follow-up study, will be needed.