Ommaya reservoir placement followed by Gamma Knife surgery for large cystic metastatic brain tumors

Yamanaka, Yuji; Shuto, Takashi; Kato, Yoriko; Okada, Taiji; Inomori, Shigeo; Fujino, Hiroyuki; Nagano, Hisato

doi:10.3171/sup.2006.105.7.79

Cited by 29 publications

(36 citation statements)

References 3 publications

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“…There are a few studies describing cyst aspiration for brain metastasis prior to radiosurgery; in these, the methods and timing of the aspiration are varied (Table 3). 2,10,14,16 In most studies, a drainage tube or Ommaya reservoir was placed during cyst aspiration and radiosurgery proceeded later. However, the volume reduction rate and tumor control rates in such studies did not differ significantly from ours.…”

Section: Discussionmentioning

confidence: 99%

“…However, the volume reduction rate and tumor control rates in such studies did not differ significantly from ours. Yamanaka et al 16 placed a drainage tube or Ommaya reservoir during cyst aspiration and followed this procedure by radiosurgery up to 60 days later. Such a two-step approach is less intensive and may be more feasible at most institutions, although it may cost more time to patients and also may increase the risk of cyst fluid reaccumulation during the longer waiting period.…”

Section: Discussionmentioning

confidence: 99%

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Effectiveness of a 1-day aspiration plus Gamma Knife surgery procedure for metastatic brain tumor with a cystic component

Higuchi¹,

Kawamoto²,

Abe³

et al. 2012

JNS

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Object Gamma Knife surgery (GKS) has gained increasing relevance in the treatment of metastatic brain tumors, but many metastatic tumors contain a large cystic component and often exceed the size limit for GKS. For such lesions, the authors adopted a procedure in which stereotactic aspiration is first performed and followed immediately by GKS on the same day. In this paper, the authors describe this 1-day combined procedure and evaluate its efficacy. Methods Between 2005 and 2010, 25 cystic metastases in 25 patients were treated at Dokkyo Medical University. The patients first underwent MRI and stereotactic aspiration of the cyst while stationary in a Leksell stereotactic frame; immediately afterward, the patients underwent a second MR imaging session and Gamma Knife treatment. Tumor volume reduction, tumor control rate, and overall survival were examined. Results Tumor volume, including the cystic component, decreased from 8.0–64.2 cm3 (mean 20.3 cm3) to 3.0–36.2 cm3 (mean 10.3 cm3) following aspiration, and the volume of 24 of 25 lesions decreased to less than 16.6 cm3, which is equivalent to the volume of a 3.16-cm sphere. At least 20 Gy was delivered to the entire lesion in 24 of 25 cases. Good tumor control was obtained in 16 of 21 cases that could be evaluated during a median follow-up period of 11 months (range 1–27 months); however, reaccumulation of cyst contents was observed in 2 patients who required Ommaya reservoir placement. Conclusions The 1-day aspiration plus GKS procedure is an effective and time-efficient treatment for large cystic brain metastases.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Effectiveness of a 1-day aspiration plus Gamma Knife surgery procedure for metastatic brain tumor with a cystic component

Higuchi¹,

Kawamoto²,

Abe³

et al. 2012

JNS

View full text Add to dashboard Cite

show abstract

“…In intratumoral cysts the wall of the cyst consists of tumor cells, which obviously need treatment. 12,18 In peritumoral cysts the tumor is a nodule in the cyst wall. No tumor cells reside in the cyst wall; therefore radiation targeting of the cyst wall may not confer benefit.…”

Section: Discussionmentioning

confidence: 99%

Same-day stereotactic aspiration and Gamma Knife surgery for cystic intracranial tumors

Liu

Zhang

et al. 2012

JNS

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Object The goal of this study was to evaluate the efficacy and safety of same-day stereotactic aspiration and Gamma knife surgery (GKS) for cystic intracranial tumors. Methods Between 1996 and 2007, 77 patients harboring cystic intracranial tumors underwent a same-day procedure of MRI-guided cyst aspiration followed by GKS. The diagnoses were metastatic tumor in 43 patients, glial tumor in 12 patients, vestibular schwannoma in 10 patients, craniopharyngioma in 9 patients, and hemangioblastoma in 3 patients. Results An improvement in symptoms was achieved in 68 patients (88.3%) immediately after cyst aspiration. The mean tumor volume in this group of patients was 25.1 cm3 before aspiration and 11.1 cm3 afterward. Hemorrhage during the course of aspiration was encountered in 1 patient. Transient nausea after cyst aspiration developed in 3 patients. There was no treatment-related hematoma, seizure, neurological deficit, or infection. The median follow-up period was 16 months (range 6–108 months). Tumor control was achieved in 50 (80.6%) of 62 patients who participated in follow-up for at least 6 months. Conclusions The same-day stereotactic aspiration and GKS procedure was safe in patients with cystic brain tumors. Prompt symptom relief was obtained after cyst aspiration. The decrease in tumor volume following aspiration made GKS more effective because a higher prescription dose could be administered with a lower possibility of radiation-induced side effects.

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“…In addition, diverse types of diseases, such as primary brain tumors, fungal meningitis, toxoplasmosis and head injury, can be indications for the placement of the device [1]. However, few reports of cystic brain metastasis from lung cancer being controlled with the insertion of an Ommaya reservoir have been published in the English literature [3,4]. Takeda and colleagues reported the case of a SCLC patient with solitary cystic brain metastasis who was successfully treated with a stereotactically inserted Ommaya reservoir followed by neurosurgical resection of the tumor, and the survival time of the patient after the insertion of the device was 4 months [3].…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, intraventricular administration of some drugs, such as amphotericin B, primethamine and methotrexate, can be conducted through this device [1,2]. Although the usefulness of this device for treating cystic lesions in the brain has been previously reported, few reports of cystic brain metastases from lung cancer being controlled by the insertion of an Ommaya reservoir have been published in the English literature [3,4]. In this report, we present a case of non-small-cell lung cancer (NSCLC) with a large cystic brain metastasis that was successfully controlled with the insertion of an Ommaya reservoir.…”

Section: Introductionmentioning

confidence: 99%

Cystic brain metastasis of non-small-cell lung cancer successfully controlled with Ommaya reservoir placement

et al. 2012

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A 68-year-old male presented with hoarseness and anarthria. Computed tomography showed an irregular nodular shadow in the upper lobe of the left lung with swollen multiple lymph nodes. Magnetic resonance imaging revealed a large cystic mass in the left hemisphere of the brain and multiple brain metastases in the bilateral hemispheres. A direct biopsy with bronchoscopy of the pulmonary nodule revealed the tumor to be an adenocarcinoma clinically diagnosed as stage IV. Since the largest brain metastasis continued to grow despite the administration of whole brain irradiation, insertion of an Ommaya reservoir in the cystic lesion was performed. This resulted in a reduction of the size of the brain tumor, and the patient's neurological symptoms improved. After the Ommaya reservoir was placed, stereotactic radiosurgery was performed on the largest lesion. The patient is doing well at 6 months after the Ommaya reservoir was inserted and is currently undergoing chemotherapy. In conclusion, the placement of an Ommaya reservoir may therefore be a potentially useful therapeutic procedure to improve the neurological symptoms and performance status in nonsmall-cell lung cancer patients with cystic brain metastasis, thereby allowing further neurosurgical therapy and chemotherapy.

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Ommaya reservoir placement followed by Gamma Knife surgery for large cystic metastatic brain tumors

Cited by 29 publications

References 3 publications

Effectiveness of a 1-day aspiration plus Gamma Knife surgery procedure for metastatic brain tumor with a cystic component

Effectiveness of a 1-day aspiration plus Gamma Knife surgery procedure for metastatic brain tumor with a cystic component

Same-day stereotactic aspiration and Gamma Knife surgery for cystic intracranial tumors

Cystic brain metastasis of non-small-cell lung cancer successfully controlled with Ommaya reservoir placement

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