The Comparative Treatment of Intraventricular Chemotherapy by Ommaya Reservoir vs. Lumbar Puncture in Patients With Leptomeningeal Carcinomatosis

Abstract

Object: Leptomeningeal Carcinomatosis (LCM) represents a state of systemic malignant disease with poor prognosis. The purpose of this study is to compare overall survival (OS) between intraventricular chemotherapy through Ommaya reservoir (OR) and chemotherapy through lumbar puncture (LP) in LCM.Patients and Methods: Forty adult patients with LCM were included. All patients underwent lumbar puncture and Magnetic resonance imaging (MRI). Thirty patients received chemotherapy through LP and 10 undergone colocation of Ommaya reservoir for intraventricular chemotherapy.Results: The most common symptom was headache (Present in 50%). The cranial nerves most affected were VI and VII. Leptomeningeal enhancement was the most frequent finding in MRI. The OS in the LP group was 4 months and Ommaya group was 9.2 months (p = 0.0006; CI:1.8-3), with statistical differences in favor to Intraventricular treatment. Proportional hazard regression showed that receiving chemotherapy through Ommaya reservoir was a protective factor (Hazard ratio = 0.258, Standard Error = 0.112, p = 0.002 and 95% CI 0.110-0.606). Using KPS as a factor did not affect the hazard ratio of Ommaya reservoir itself.Conclusions: OS was significantly higher in patients with Ommaya reservoir in spite of Karnofsky Performance Status (KPS) previous to chemotherapy. Therefore, intraventricular chemotherapy should be preferred over lumbar puncture chemotherapy administration if there are resources available.

Troubleshooting an unusual complication following intrathecal chemotherapy delivered via Ommaya catheter: A case report

“…However, an Ommaya reservoir was deemed appropriate in this case due to the patient's severe spinal headache following her initial lumbar puncture, as well as her requirement for repeated intrathecal chemotherapy delivery. Using an Ommaya reservoir minimizes patient discomfort and takes advantage of the natural flow of CSF, providing a more direct delivery and even distribution of chemotherapy along the CNS axis as compared to lumbar puncture (5).…”

“…Patients' comfort and other psychological factors often play a significant role in evaluating its use (4). Ommaya reservoir use for chemotherapy administration has in some settings (e.g., leptomeningeal malignancy) shown higher overall survival compared to intrathecal chemotherapy via lumbar puncture (5). It has been used more extensively as image guidance techniques have advanced (6).…”

Clinical Features of Diffuse Leptomeningeal Glioneuronal Tumor With the First Symptom of Headache and Decreased Vision Misdiagnosed as Venous Sinus Thrombosis

“…DLGNT is rare, there is no effective cure, and the mortality rate is high. Early diagnosis can improve the quality of life and prolong survival [21][22][23][24]. However, in the current situation, clinical symptoms are not typical, and the first doctor lacks relevant clinical experience.…”

Leptomeningeal Spread in Glioblastoma: Diagnostic and Therapeutic Challenges

“…Cranial nerve deficits, including of the second, third, fourth, sixth, and/or seventh, are observed in 6% of cases [8, 78]. The fourth and seventh cranial nerves are the most frequently involved [78, 82]. Once installed, cranial nerve palsies are often irreversible [5, 27].…”

“…Progression of the disease or treatment‐related complications (such as hemorrhage [129] and infections [20, 33] after intrathecal administrated treatment or ventriculoperitoneal shunting [20, 130, 131]) may sometimes contribute to the fatal outcome [82, 129].…”