Application of the ommaya reservoir in the treatment of hydrocephalus in prematurely born children: Correlation with animal results

Mihajlovic, Miljan; Mrdak, Milan; Radlovic, Vladimir; Nikolić, Igor; Rakić, Mia; Repac, Nikola; Antunović, Vaso; Janićijević, A.; Šćepanović, V.; Tasić, Goran; Dučić, Siniša

doi:10.2298/sarh1302008m

Cited by 2 publications

(3 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Several single-center series report the incidence of shunt placement in these children using either subcutaneous reservoirs for intermittent percutaneous removal of CSF or ventriculosubgaleal shunt (VSGS) placement. 3,[6][7][8][9]11,16,17,19,22,23,[25][26][27] Two recent notable publications report the retrospectively reviewed single-center experience using both. 14,28 In 2009, the Hydrocephalus Clinical Research Network (HCRN) published an initial paper in which the permanent shunt rates were evaluated in a 147-patient retrospective nonstandardized cohort.…”

mentioning

confidence: 99%

Shunting outcomes in posthemorrhagic hydrocephalus: results of a Hydrocephalus Clinical Research Network prospective cohort study

Wellons

Shannon

Holubkov³

et al. 2017

Journal of Neurosurgery: Pediatrics

104

View full text Add to dashboard Cite

OBJECTIVEPrevious Hydrocephalus Clinical Research Network (HCRN) retrospective studies have shown a 15% difference in rates of conversion to permanent shunts with the use of ventriculosubgaleal shunts (VSGSs) versus ventricular reservoirs (VRs) as temporization procedures in the treatment of hydrocephalus due to high-grade intraventricular hemorrhage (IVH) of prematurity. Further research in the same study line revealed a strong influence of center-specific decision-making on shunt outcomes. The primary goal of this prospective study was to standardize decision-making across centers to determine true procedural superiority, if any, of VSGS versus VR as a temporization procedure in high-grade IVH of prematurity.METHODSThe HCRN conducted a prospective cohort study across 6 centers with an approximate 1.5- to 3-year accrual period (depending on center) followed by 6 months of follow-up. Infants with premature birth, who weighed less than 1500 g, had Grade 3 or 4 IVH of prematurity, and had more than 72 hours of life expectancy were included in the study. Based on a priori consensus, decisions were standardized regarding the timing of initial surgical treatment, upfront shunt versus temporization procedure (VR or VSGS), and when to convert a VR or VSGS to a permanent shunt. Physical examination assessment and surgical technique were also standardized. The primary outcome was the proportion of infants who underwent conversion to a permanent shunt. The major secondary outcomes of interest included infection and other complication rates.RESULTSOne hundred forty-five premature infants were enrolled and met criteria for analysis. Using the standardized decision rubrics, 28 infants never reached the threshold for treatment, 11 initially received permanent shunts, 4 were initially treated with endoscopic third ventriculostomy (ETV), and 102 underwent a temporization procedure (36 with VSGSs and 66 with VRs). The 2 temporization cohorts were similar in terms of sex, race, IVH grade, head (orbitofrontal) circumference, and ventricular size at temporization. There were statistically significant differences noted between groups in gestational age, birth weight, and bilaterality of clot burden that were controlled for in post hoc analysis. By Kaplan-Meier analysis, the 180-day rates of conversion to permanent shunts were 63.5% for VSGS and 74.0% for VR (p = 0.36, log-rank test). The infection rate for VSGS was 14% (5/36) and for VR was 17% (11/66; p = 0.71). The overall compliance rate with the standardized decision rubrics was noted to be 90% for all surgeons.CONCLUSIONSA standardized protocol was instituted across all centers of the HCRN. Compliance was high. Choice of temporization techniques in premature infants with IVH does not appear to influence rates of conversion to permanent ventricular CSF diversion. Once management decisions and surgical techniques are standardized across HCRN sites, thus minimizing center effect, the observed difference in conversion rates between VSGSs and VRs is mitigated.

show abstract

mentioning

confidence: 99%

Shunting outcomes in posthemorrhagic hydrocephalus: results of a Hydrocephalus Clinical Research Network prospective cohort study

Wellons

Shannon

Holubkov³

et al. 2017

Journal of Neurosurgery: Pediatrics

104

View full text Add to dashboard Cite

show abstract

“…With continuous advancements in disease diagnosis and treatment, the Ommaya reservoir is now used in the treatment of various nervous system diseases ( 19 ). The main advantage of the Ommaya reservoir is that it can be used for a long time, even for several years, and can be repeatedly punctured and drained ( 10 , 11 ). The Ommaya reservoir is also an effective way to treat HII.…”

Section: Discussionmentioning

confidence: 99%

“…The Ommaya reservoir is placed under the scalp and the other end is placed in the ventricle. The Ommaya reservoir allows for intermittent aspiration of CSF and drug delivery into the CSF to treat hydrocephalus, intracranial infection, or ventricular hemorrhage ( 10 , 11 ). C-EVD improves the symptoms of hydrocephalus in emergency situations but cannot usually effectively control intracranial infection in a short term, while long-term C-EVD devices may cause retrograde intracranial infection, which may aggravate the condition ( 12 , 13 ).…”

Section: Introductionmentioning

confidence: 99%

Effects of modified external ventricular drainage vs. an Ommaya reservoir in the management of hydrocephalus with intracranial infection in pediatric patients

Chen,

He,

Shi

et al. 2024

Front. Neurol.

View full text Add to dashboard Cite

BackgroundHydrocephalus with intracranial infection (HII) may cause pathological changes in brain tissue structure and irreversible damage to the nervous system. However, intracranial infection is a contraindication to ventriculo-peritoneal (VP) shunt surgery, and the prognosis is improved by early infection control and intracranial pressure reduction. This study evaluated the safety and efficacy of the Ommaya reservoir vs. modified external ventricular drainage (M-EVD) in the management of HII in pediatric patients.MethodsThis retrospective controlled study included 45 pediatric patients with HII treated with an Ommaya reservoir (n = 24) or M-EVD (n = 21) between January 2018 and December 2022. Clinical outcomes, cerebrospinal fluid (CSF) test results, complications, and outcomes were compared between the Ommaya reservoir and M-EVD groups.ResultsNo patient died during the follow-up period. The two groups were similar regarding age, sex, admission temperature, weight, preoperative serum protein and albumin concentrations, CSF analysis (white blood cell count, glucose concentration, and protein content), and clinical symptoms (P > 0.05). Both groups had significant changes in the CSF test results postoperatively compared with preoperatively (P < 0.05). In the M-EVD group, the median days for 13 children to remove the external drainage tube and receive VP shunt was 19 days. The longest drainage tube retention time was 61 days, and there was no intracranial infection or serious complication related to the drainage tube. After the placement of the Ommaya, the median time required for CSF to return to normal was 21 days, and a total of 15 patients underwent VP shunt surgery.ConclusionThe Ommaya reservoir and M-EVD are safe and effective for pediatric patients with HII. Both methods reduce the intracranial pressure and alleviate the symptoms of hydrocephalus, although there are differences between the two methods.

show abstract

Application of the ommaya reservoir in the treatment of hydrocephalus in prematurely born children: Correlation with animal results

Cited by 2 publications

References 36 publications

Shunting outcomes in posthemorrhagic hydrocephalus: results of a Hydrocephalus Clinical Research Network prospective cohort study

Shunting outcomes in posthemorrhagic hydrocephalus: results of a Hydrocephalus Clinical Research Network prospective cohort study

Effects of modified external ventricular drainage vs. an Ommaya reservoir in the management of hydrocephalus with intracranial infection in pediatric patients

Contact Info

Product

Resources

About