Optimal implantation of Ommaya reservoirs for cystic metastatic brain tumors preceding Gamma Knife radiosurgery

Oshima, Akito; Kimura, Toshikazu; Akabane, Atsuya; Kawai, Kensuke

doi:10.1016/j.jocn.2016.12.042

Cited by 11 publications

(6 citation statements)

References 12 publications

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“…The volumetric decrease reported in the literature ranged from 47.8% to 77.9% ( 6 , 9 , 14 – 17 ). Akito Oshima reported that the degree of tumor volume reduction depended on the location of the puncture target ( 16 ). He suggested that the tip of the puncture needle should be placed at the center of the cyst to ensure adequate volume reduction.…”

Section: Discussionmentioning

confidence: 99%

Case Report: Clinical and Procedural Implications of Ommaya Reservoir Implantation in Cystic Brain Metastases Followed by Radiosurgery Treatment

Wang

et al. 2022

Front. Surg.

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BackgroundTherapy for large or deep cystic brain metastases is a troublesome procedure in clinical departments. Stereotactic cyst aspiration, combined with Gamma Knife radiosurgery, can be an effective treatment for cystic brain metastases. However, there is still a possibility that a reaccumulation of cystic fluid may lead to poor efficacy or even reoperation.Case presentationWe present a case of a 67-year-old man who was diagnosed with lung cancer brain metastasis. The intracranial lesion seen on imaging appeared to be cystic and located deep inside the brain with associated limb dysfunction. The patient did not respond well to chemotherapy and underwent cyst aspiration with Ommaya reservoir implantation under neuronavigation. Repeated cystic fluid reaccumulation and exacerbation of symptoms occurred during treatment. We performed repeated aspiration via the Ommaya reservoir to control the symptoms and combined it with radiotherapy. During the follow-up period of 14 months, the intracranial tumor was effectively and satisfactorily controlled.ConclusionsWe highlight that Ommaya reservoir implantation during stereotactic cyst aspiration is necessary to prevent fluid reaccumulation, thereby avoiding the need for a second surgical procedure.

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Section: Discussionmentioning

confidence: 99%

Case Report: Clinical and Procedural Implications of Ommaya Reservoir Implantation in Cystic Brain Metastases Followed by Radiosurgery Treatment

Wang

et al. 2022

Front. Surg.

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“…The tumor reduction rate is reported to be 52.6-77.9% of the volume [6, 7, 9, 14], consistent with our case series. Oshima et al reported that successful catheter placement contributes to effective tumor reduction; the catheter tip should be placed in the cyst center to achieve maximum reduction of the cystic tumor [9]. We adopted this method for our cases by using an intraoperative navigation system.…”

Section: Discussionmentioning

confidence: 99%

“…Reducing the tumor volume by aspirating the encapsulated uid facilitates GKRS. The combination of stereotactic tumor aspiration and GKRS has been reported to be effective for large cystic metastases [6][7][8][9][10][11][12][13][14]; however, even after aspiration, the tumor may remain larger than the size of a suitable candidate for GKRS. The irregular shape of the shrunken cyst is also challenging to treat.…”

Section: Introductionmentioning

confidence: 99%

Fractionated Gamma Knife Radiosurgery Combined with Ommaya Reservoir Implantation for Large Cystic Brain Metastases.

Noda¹,

Akabane²,

Kawashima³

et al. 2022

Preprint

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Introduction: Large cystic brain metastases are relatively rare and are not good candidates for stereotactic radiosurgery. Stereotactic aspiration followed by Gamma Knife radiosurgery (GKRS) is a reasonable and effective management strategy. However, even with aspiration, the target lesion tends to exceed the dimensions of an ideal target for stereotactic radiosurgery. This study aimed to investigate the effectiveness of frameless fractionated GKRS (f-GKRS) for large cystic brain metastases with cyst aspiration using Ommaya reservoir implantation. Methods: Between May 2018 and April 2021, eight consecutive patients with nine lesions were treated with f-GKRS in five or ten sessions after cyst aspiration. The aspiration was repeated as needed throughout the treatment course to maintain the cyst size and shape. The patient characteristics, radiologic tumor response, and clinical course were reviewed using medical records. The mean follow-up duration was 10.2 months (2–28 months). Results: The mean pre-GKRS volume and maximum diameter were 16.7 mL (5–55.8 mL) and 39.0 mm (31–79 mm), respectively, and the mean tumor volume reduction achieved by aspiration was 55.4%. The tumor volume decreased for all lesions, and symptoms were alleviated in all patients. The median overall survival was 10.0 months, and the estimated one-year survival rate was 41.7% (95% CI: 10.9–70.8%). The local tumor control rate was 100%. No irradiation-related adverse events were observed. Conclusions: Ommaya reservoir implantation and aspiration followed by frameless f-GKRS is a less invasive, effective, and safe method, and should be considered as a management option for large cystic brain metastases.

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“…Volumetric decrease reported in the literature ranged from 47.8% to 77.9%(6, 9, 12-15). Akito Oshima reported the degree of tumor volume reduction depended on the location of puncture target (14). He suggested that the tip of the puncture needle should be placed at the center of the cyst to ensure adequate volume reduction.…”

Section: Discussionmentioning

confidence: 99%

Clinical and procedural implications of ommaya reservoirs implantation in cystic brain metastases followed by radiosurgery treatment

Han

et al. 2022

Preprint

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Background: The therapy to large or deep cystic brain metastases is a troublesome problem in clinical department. Stereotactic cyst aspiration combined with Gamma Knife radiosurgery can be an effective treatment for cystic brain metastases. However, there is still a possibility that reaccumulation of cystic fluid may lead to poor efficacy or even reoperation.Case presentation: We present a case of a 67-year-old man who diagnosed with brain metastasis of lung cancer. The intracranial lesion represented in imaging appeared to be cystic and located deep in the brain with the patient’s limb dysfunction. The patient did not respond well to chemotherapy and underwent cyst aspiration with ommaya reservoir implantation. Although turbid fluid may lead to postoperative tube blockage, we still implanted an ommaya reservoir. Repeated cystic fluid reaccumulation and exacerbation of symptoms occurred during treatment. Fortunately, the ommaya reservoir is not blocked. We performed repeated aspiration via ommaya reservoir to cope with such a situation and combined with radiotherapy. During the follow-up period of 14 months, the intracranial tumor was effectively and satisfactorily controlled.Conclusions: We highlight that an ommaya reservoir implantation during stereotactic cyst aspiration is necessary to prevent fluid reacclumulation avoiding the need for a second surgical procedure.

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Optimal implantation of Ommaya reservoirs for cystic metastatic brain tumors preceding Gamma Knife radiosurgery

Cited by 11 publications

References 12 publications

Case Report: Clinical and Procedural Implications of Ommaya Reservoir Implantation in Cystic Brain Metastases Followed by Radiosurgery Treatment

Case Report: Clinical and Procedural Implications of Ommaya Reservoir Implantation in Cystic Brain Metastases Followed by Radiosurgery Treatment

Fractionated Gamma Knife Radiosurgery Combined with Ommaya Reservoir Implantation for Large Cystic Brain Metastases.

Clinical and procedural implications of ommaya reservoirs implantation in cystic brain metastases followed by radiosurgery treatment

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