An Ommaya reservoir is mainly a plastic-based drug delivery system characterized as an intraventricular catheter system that consists of a catheter in an adjacent ventricle further attached to a tank which is inserted under the scalp area.
This system majorly used in chemotherapy for the delivery or direct administration of the drugs into the cerebrospinal fluid as well as for the aspiration of the cerebrospinal fluid. It is a widely adopted treatment option among professionals to treat brain tumors, leukemia/lymphoma, or leptomenizngeal disease via chemotherapy provided by this catheter system. During palliative care among the terminal cases of cancer, the Ommaya reservoir is widely used for the continuous administration of the morphine.
This delivery system was initially introduced by a Pakistan national neurosurgeon resident in America named Ayub K. Ommaya, in 1963.
As the normal administration of many of the drugs through natural routes cannot surpass the blood-brain barrier to reach cerebrospinal fluid (CSF) and in this case, the Ommaya reservoir can be used allowing direct insertion of the chemotherapeutics in CSF. It allows the professionals to take samples of CSF without the performance of spinal tapping as well as the measurement of intracranial pressure can be taken with this instrument.
It is made of plastic material and consists of two major parts. The first part involves a small dome-shaped container and inserted under the scalp of the patient. The other part consists of a catheter that is connected to the first part (container) that is inserted in the ventricle of the brain commonly characterized as open space. CSF flows through this ventricle for the provision of nutrients and cushioning to the brain, meanwhile allowing the direct entry of chemotherapeutics through this device.
A needle is inserted directly in the ventricle through the skin of the scalp to reach out to the reservoir to deliver the medications or to take any samples.
Ommaya Reservoir Complications
Generally; the Ommaya reservoirs are safe to carry out among patients but the insertion of this device may bring some complications with it. These are very similar to the risks faced during any other surgical procedure.
These complications may involve;
- Development of infection
- Bleeding into the brain
- Neurological impairment (characterized by partial loss of the brain function)
To avoid the occurrence of any kind of infection from this procedure, professionals suggest the use of antibiotics beforehand. If the patient still poses any infection then further approaches are adopted to minimize the risks.
In some cases, problems have been observed in the placement of the device which requires an MRI to understand the exact situation. If the MRI confirms the disposition of the catheter or reservoir then further procedures are suggested to be performed immediately for the repositioning of the specified device.
Ommaya Reservoir Removal
The removal of Ommaya reservoirs is generally not considered in the practice as its existence does not present any kind of risks. But the removal of this instrument from the brain comes out with the same risks and complications that were posed at the time of insertion. So, the professionals suggest keeping it in even after the patient no longer needs this device. Unless the development of any kind of infection presented due to the insertion of this device in the localized area requires immediate removal.
However, in normal cases before going for the removal option every possible risk of the procedure must be outweighed beforehand.
Ommaya Reservoir Indications
After the insertion of the Ommaya reservoir, an MRI is usually performed to make sure the accurate placement of this device. In case of any disposition, a follow-up procedure is recommended for the required corrections. After the accurate placement, the patient may feel the presence of it at the back of the head in the form of a small bump.
After the placement procedure is completed, the patient is advised to keep the area dry and clean until the removal of staples or stitches to remove the possibility of any infection. But the patient must look for the following signs to outweigh the chances of occurrence of infection, including;
- Elevated body temperature (fever)
- Frequent headaches
- Redness or stiffness near the incision site
- Oozing near the incision site
- Neck stiffness
After the healing process the patients are allowed to go to their routine activities as this device does not require any extra precaution or maintenance.
Ommaya Reservoir Side Effects
Minor side effects are very common among the patients after the placement procedure of the Ommaya reservoir, which may include;
- Experiencing pain at the time of insertion of the needle at the localized area
- Frequent headaches
- Nausea or vomiting after the procedure
In these cases, patients are recommended to lie down for the sake of rest after the procedure is completed. After the reduction in the side effects, patients are freely allowed to get back to their normal routines.