Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Clinical Safety and Efficiency of the H-Port for Treatment of Leptomeningeal Metastasis

  • Sung-Min Jang (Department of Neurosurgery, Seoul National University Hospital) ;
  • Ho-Shin Gwak (Department of Cancer Control, Graduate School of Cancer Science and Policy, National Cancer Center) ;
  • Ji-Woong Kwon (Neuro-Oncology Clinic, National Cancer Center) ;
  • Sang Hoon Shin (Neuro-Oncology Clinic, National Cancer Center) ;
  • Heon Yoo (Neuro-Oncology Clinic, National Cancer Center)
  • Received : 2023.08.26
  • Accepted : 2023.12.07
  • Published : 2024.07.01
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Abstract

Objective : To evaluate the usefulness of a cranial implantable chemoport, the H-port, as an alternative to the Ommaya reservoir for intraventricular chemotherapy/cerebrospinal fluid (CSF) access in patients with leptomeningeal metastasis (LM). Methods : One hundred fifty-two consecutive patients with a diagnosis of LM and who underwent H-port installation between 2015 and 2021 were evaluated. Adverse events associated with installation and intraventricular chemotherapy, and the rate of increased intracranial pressure (ICP) control via the port were evaluated for safety and efficacy. These indices were compared with published data of Ommaya (n=89), from our institution. Results : Time-to-install and installation-related complications of intracranial hemorrhage (n=2) and catheter malposition (n=5) were not significantly different between the two groups. Intraventricular chemotherapy-related complications of CSF leakage occurred more frequently in the Ommaya than in the H-port group (13/89 vs. 3/152, respectively, p<0.001). Intracranial hemorrhage during chemotherapy occurred only in the Ommaya group (n=4). The CSF infection rate was not statistically different between groups (14/152 vs. 12/89, respectively). The ICP control rate according to reservoir type revealed a significantly higher ICP control rate with the H-port (40/67), compared with the Ommaya result (12/58, p<0.001). Analyzing the ICP control rate based on the CSF drainage method, continuous extraventricular drainage (implemented only with the H-port), found a significantly higher ICP control rate than with intermittent CSF drainage (33/40 vs. 6/56, respectively, p<0.0001). Conclusion : The H-port for intraventricular chemotherapy in patients with LM was superior for ICP control; it had equal or lower complication rates than the Ommaya reservoir.

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References

  1. Bleyer WA, Pizzo PA, Spence AM, Platt WD, Benjamin DR, Kolins CJ, et al. : The Ommaya reservoir: newly recognized complications and recommendations for insertion and use. Cancer 41 : 2431-2437, 1978
  2. Byun YH, Gwak HS, Kwon JW, Kim KG, Shin SH, Lee SH, et al. : A novel implantable cerebrospinal fluid reservoir : a pilot study. J Korean Neurosurg Soc 61 : 640-644, 2018
  3. Chamberlain MC : Leptomeningeal metastases: a review of evaluation and treatment. J Neurooncol 37 : 271-284, 1998
  4. Chamberlain MC : Radioisotope CSF flow studies in leptomeningeal metastases. J Neurooncol 38 : 135-140, 1998
  5. Chamberlain MC, Kormanik P : Carcinoma meningitis secondary to non-small cell lung cancer: combined modality therapy. Arch Neurol 55 : 506-512, 1998
  6. Chamberlain MC, Kormanik PA : Prognostic significance of 111 indiumDTPA CSF flow studies in leptomeningeal metastases. Neurology 46 : 1674-1677, 1996
  7. Chamberlain MC, Kormanik PA, Barba D : Complications associated with intraventricular chemotherapy in patients with leptomeningeal metastases. J Neurosurg 87 : 694-699, 1997
  8. Chen Y, Liu L, Zhu M : Intraventricular administration of antibiotics by ommaya reservoir for patients with multidrug-resistant Acinetobacter baumannii central nervous system infection. Br J Neurosurg 35 : 170-173, 2021
  9. Gwak HS, Joo J, Kim S, Yoo H, Shin SH, Han JY, et al. : Analysis of treatment outcomes of intraventricular chemotherapy in 105 patients for leptomeningeal carcinomatosis from non-small-cell lung cancer. J Thorac Oncol 8 : 599-605, 2013
  10. Gwak HS, Lee CH, Yang HS, Joo J, Shin SH, Yoo H, et al. : Chemoport with a non-collapsible chamber as a replacement for an Ommaya reservoir in the treatment of leptomeningeal carcinomatosis. Acta Neurochir (Wien) 153 : 1971-1978; discussion 1978, 2011
  11. Hitchins RN, Bell DR, Woods RL, Levi JA : A prospective randomized trial of single-agent versus combination chemotherapy in meningeal carcinomatosis. J Clin Oncol 5 : 1655-1662, 1987
  12. Jacobs A, Clifford P, Kay HE : The Ommaya reservoir in chemotherapy for malignant disease in the CNS. Clin Oncol 7 : 123-129, 1981
  13. Jung TY, Chung WK, Oh IJ : The prognostic significance of surgically treated hydrocephalus in leptomeningeal metastases. Clin Neurol Neurosurg 119 : 80-83, 2014
  14. Kim HS, Park JB, Gwak HS, Kwon JW, Shin SH, Yoo H : Clinical outcome of cerebrospinal fluid shunts in patients with leptomeningeal carcinomatosis. World J Surg Oncol 17 : 59, 2019
  15. Lee TL, Kumar A, Baratham G : Intraventricular morphine for intractable craniofacial pain. Singapore Med J 31 : 273-276, 1990
  16. Lemann W, Wiley RG, Posner JB : Leukoencephalopathy complicating intraventricular catheters: clinical, radiographic and pathologic study of 10 cases. J Neurooncol 6 : 67-74, 1988
  17. Lishner M, Perrin RG, Feld R, Messner HA, Tuffnell PG, Elhakim T, et al. : Complications associated with Ommaya reservoirs in patients with cancer. The Princess Margaret Hospital experience and a review of the literature. Arch Intern Med 150 : 173-176, 1990
  18. Liu HG, Liu DF, Zhang K, Meng FG, Yang AC, Zhang JG : Clinical application of a neurosurgical robot in intracranial ommaya reservoir implantation. Front Neurorobot 15 : 638633, 2021
  19. Obbens EA, Leavens ME, Beal JW, Lee YY : Ommaya reservoirs in 387 cancer patients: a 15-year experience. Neurology 35 : 1274-1278, 1985
  20. Ommaya AK : Subcutaneous reservoir and pump for sterile access to ventricular cerebrospinal fluid. Lancet 2 : 983-984, 1963
  21. Ongerboer de Visser BW, Somers R, Nooyen WH, van Heerde P, Hart AA, McVie JG : Intraventricular methotrexate therapy of leptomeningeal metastasis from breast carcinoma. Neurology 33 : 1565-1572, 1983
  22. Rogers LR, Barnett G : Percutaneous aspiration of brain tumor cysts via the Ommaya reservoir system. Neurology 41(2_part_1) : 279-282, 1991
  23. Sandberg DI, Bilsky MH, Souweidane MM, Bzdil J, Gutin PH : Ommaya reservoirs for the treatment of leptomeningeal metastases. Neurosurgery 47 : 49-54; discussion 54-55, 2000
  24. Taillibert S, Laigle-Donadey F, Chodkiewicz C, Sanson M, Hoang-Xuan K, Delattre JY : Leptomeningeal metastases from solid malignancy: a review. J Neurooncol 75 : 85-99, 2005
  25. Takahashi M, Yamada R, Tabei Y, Nakamura O, Shinoura N : Navigation-guided Ommaya reservoir placement: implications for the treatment of leptomeningeal metastases. Minim Invasive Neurosurg 50 : 340-345, 2007
  26. Vinchurkar KM, Maste P, Togale MD, Pattanshetti VM : Chemoport-associated complications and its management. Indian J Surg Oncol 11 : 394-397, 2020
  27. Wasserstrom WR, Glass JP, Posner JB : Diagnosis and treatment of leptomeningeal metastases from solid tumors: experience with 90 patients. Cancer 49 : 759-772, 1982
  28. Zubair A, De Jesus O : Ommaya Reservoir : StatPearls. Treasure Island : StatPearls Publishing, 2022