Safe Placement of Ommaya Reservoirs in Thrombocytopenic Patients: One Institutions Experience

Abstract

ObjectiveThe purpose of this study was to assess the risk of hemorrhagic complications in thrombocytopenic patients after Ommaya reservoir placement.MethodsBetween 2009 and 2017, 192 patients were identified on the National Neoplastic Meningitis Registry and had undergone Ommaya reservoir placement for intrathecal chemotherapy. A retrospective chart review was performed to collect the preoperative and postoperative platelet levels, whether or not the patient received any transfusion of platelets, neurological exams, and whether a postoperative head CT was obtained. Using generally accepted recommendations, a platelet level less than 100,000/μL was considered clinically significant and used as our threshold for thrombocytopenia.ResultsSeven patients (3.6%) were identified as thrombocytopenic in our patient population with platelet counts ranging from 54,000 to 99,000/μL. Primary diagnoses for the seven patients included leukemia, prostate cancer, primary brain cancer (four patients), and lung cancer (non-small-cell lung carcinoma). One patient received platelet transfusions preoperatively. Three patients had a routine head CT obtained postoperatively with no abnormal findings noted. There were no changes in the neurological exam noted in all of the patients included in this study. No clinically significant hemorrhages were identified in our patients.ConclusionsFrom our single institutional experience, we found that thrombocytopenia is fairly uncommon, found in only 3.6% of our patients undergoing placement of Ommaya reservoirs. We did not encounter any increased risks of postoperative hemorrhage in studied thrombocytopenic patients.

A new approach for leptomeningeal metastases: chemotherapy administered through lumbar intrathecal port

“…Implantation of an Ommaya reservoir requires surgery and offers certain advantages in terms of patient compliance, along with better diffusion of the chemotherapeutic agent into the meninges [8][9][10] . Although implantation of Ommaya reservoirs is considered to be a relatively safe procedure, as shown by acceptable perioperative complication rates [10][11][12] and a report on potential applicability among thrombocytopenic patients 13 , their use has also been reported to be associated with significant potential risks. Although image-guided techniques have been used to negate the high risk associated with this procedure, the reported rate of serious complications remains around 8.5% 14,15 .…”