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The Princess Margaret Hospital Experience and a Review of the Literature

Michael Lishner, MD; Richard G. Perrin, MD; Ronald Feld, MD; Hans A. Messner, MD; Peter G. Tuffnell, FRCPath; Tahany Elhakim, MSc; Anne Matlow, MD; John E. Curtis, MD

Arch Intern Med. 1990;150(1):173-176.

Abstract
• The complications associated with the use of Ommaya reservoirs in 106 patients with meningeal involvement due to malignant disease are reviewed. Twenty-seven patients had acute lymphoblastic leukemia, 12 acute myelogenous leukemia, 3 chronic lymphocytic leukemia, 34 lymphoma, 29 carcinoma, and 1 chronic myelocytic leukemia. There were 11 technical complications, including 1 death due to misplacement of the catheter, 2 mild intraventricular hemorrhages, and 5 malfunctioning reservoirs; 3 required craniotomies (1 for subdural hematoma and 2 for subdural hygroma); 13 cases of bacterial meningitis occurred in 10 patients. One patient died of Staphylococcus aureus meningitis. The organisms causing the other infections were mainly coagulase-negative staphylococci (8 cases) or Propionibacterium acnes (2 cases). The projected infection rate for all patients (by Kaplan-Meier analysis) during the first year following insertion of a reservoir was 15%. Successful use of Ommaya reservoirs requires expert surgical implantation and meticulous care during accessing to minimize complications.

(Arch Intern Med. 1990;150:173-176)

Author Affiliations
From the Departments of Medicine and Pathology, Ontario Cancer Institute, (Drs Lishner, Feld, Messner, Tuffnell, Elhakim, and Curtis) and Departments of Surgery and Medicine, Wellesley Hospital (Drs Perrin and Matlow), Toronto, Canada.

Footnotes
Accepted for publication August 15,1989.

Presented at the American Society of Clinical Oncology meeting, New Orleans, La, May 1988.

Reprint requests to Ontario Cancer Institute, 500 Sherbourne St, Toronto, Ontario, Canada M4X1K9 (Dr Curtis).

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