Safety profile of long-term intraventricular access devices in pediatric patients receiving radioimmunotherapy for central nervous system malignancies.
BACKGROUND
The use of Ommaya catheters or ventriculoperitoneal shunts with programmable valves (pVP-shunts) for intraventricular drug administration is increasingly more common.


METHODS
We reviewed the safety and complication rate associated with ventricular access devices in patients receiving compartmental intraventricular radioimmunotherapy (cRIT).


RESULTS
One hundred fifty one patients with recurrent primary or metastatic central nervous system (CNS) tumors (1-34 years) had a ventricular access device (143 Ommaya reservoirs, 8 VP shunts with programmable valves) placed for drug administration and cerebrospinal fluid acquisition. Patients received 2-5 serial injections (124) I- or (131) I- labeled monoclonal antibody 3F8 or 8H9. For each injection, catheters remained accessed for pharmacokinetic studies up to 48 hours or were individually accessed 3-6×/injection. Thereafter catheters were accessed for periodic routine cytology. Six patients (4%) had complications including three with catheter migration in the newly-placed setting requiring surgical revision. Two patients had pericatheter cyst formation (with cyst formation before radioimmunotherapy administration in one patient) resulting in elective removal and endoscopic cystoventriculostomy in both patients. There were no catheter-related infections, hemorrhages, seizures, focal deficits, or valve malfunctioning. Four patients later required Ommaya conversion to VP shunts because of hydrocephalus secondary to disease progression.


CONCLUSIONS
We report a long-term safety profile of ventricular access devices in patients receiving cRIT. Minimal acute complications are observed despite the frequency of cerebrospinal fluid acquisition; long-term complications are rare. Programmable VP shunts appear to be a safe and effective alternative to Ommaya catheters.
Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, New York.
Kim
K
Kramer
Mariel
M
Smith
Mark M
MM
Souweidane
D000293:Adolescent; D000328:Adult; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D002404:Catheterization; D016543:Central Nervous System Neoplasms / Q000276:immunology / Q000473:pathology / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D016503:Drug Delivery Systems; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007276:Injections, Intraventricular / Q000009:adverse effects / Q000295:instrumentation*; D007457:Iodine Radioisotopes / Q000627:therapeutic use*; D008297:Male; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000276:immunology / Q000473:pathology / Q000628:therapy; D009367:Neoplasm Staging; D011379:Prognosis; D016499:Radioimmunotherapy; D012449:Safety; D013997:Time Factors; D017287:Ventriculoperitoneal Shunt; D055815:Young Adult
D000911:Antibodies, Monoclonal; D007457:Iodine Radioisotopes
CNS metastases; intraventricular access devices; ommaya; radioimmunotherapy