Ommaya Reservoir

Excerpt

Ommaya reservoir is a ventricular access device for the purpose of repetitive access to the intrathecal space. This device is named after its inventor, a Pakistani neurosurgeon Ayub Khan Ommaya in 1963. Though initially conceived for delivery of antifungal medications into the cerebrospinal fluid (CSF), this device is commonly used today for chemotherapeutic central nervous system (CNS) delivery and CSF sampling. The Ommaya reservoir has replaced repeated intrathecal injections (via lumbar or suboccipital puncture) in the administration of antineoplastic drug delivery. This device permits repeated administration of chemotherapeutic drugs without doing a lumbar puncture, allows CSF sampling for the dose titration, and provides consistent intrathecal drug concentrations.

For many decades, the Ommaya reservoir was inserted by a freehand technique. If ventriculomegaly is not present, accurate placement of the ventricular end may often be difficult. Multiple attempts through the brain cortex can result in complications such as hemorrhage, intracranial infection, and seizures. Computed tomography-assisted stereotactic placement of the Ommaya reservoir for small or normal-sized ventricles formed the basis for future neuronavigation techniques. Since then, the insertion of the intraventricular catheter has undergone a major transformation, aided by high-resolution imaging techniques and advances in neuronavigation such as optical tracking frameless stereotactic approach, electromagnetic tracking, frame-based tracking, fluoroscopy-assisted, ultrasound-guided, robot-guided, and endoscope-guided implantations.