A Novel Approach Using Electromagnetic Neuronavigation and a Flexible Neuroendoscope for Placement of Ommaya Reservoirs.
OBJECTIVE
Placement of intraventricular catheters in oncology patients can be associated with morbidity given their small to slit-like ventricles and underlying hematologic disorders. We studied the accuracy of placing Ommaya reservoirs using neuronavigation and a flexible neuroendoscope to verify catheter positioning.


METHODS
Ommaya reservoirs placed in 25 oncology patients between 2013 and 2015 were retrospectively reviewed. Twenty-five ventricular catheters were placed using the AxiEM stealth frameless neuronavigation system and a flexible neuroendoscope. Postoperative catheter accuracy, operative complications, and postoperative complications were assessed. We discuss surgical protocol and technical nuances.


RESULTS
All ventricular catheters were successfully placed into the ipsilateral (84%) or contralateral (16%) foramen of Monro. A single ventricular catheter pass was needed to cannulate the ventricle in 96% of patients. The mean accuracy was 4.09 ± 3.47 mm from the target, the ipsilateral foramen of Monro. One patient had a catheter tract hemorrhage seen on postoperative imaging related to thrombocytopenia. No postoperative neurologic deficits were seen.


CONCLUSIONS
A combined neuronavigation and neuroendoscopic approach improved catheter tip accuracy compared with accuracy rates described in the literature using other techniques. This approach can be adapted toward routine clinical practice of placing ventricular shunt catheters and Ommaya reservoirs.
Department of Neurological Surgery, New York Medical College, Westchester, New York, USA. Electronic address: wanga@wcmc.com.
Arthur
A
Wang
Department of Radiology, New York Medical College, Westchester, New York, USA.
Michael S
MS
Tenner
Department of Neurological Surgery, New York Medical College, Westchester, New York, USA.
Michael E
ME
Tobias
Department of Neurological Surgery, New York Medical College, Westchester, New York, USA.
Avinash
A
Mohan
Department of Neurological Surgery, New York Medical College, Westchester, New York, USA.
Dolly
D
Kim
Department of Neurological Surgery, New York Medical College, Westchester, New York, USA.
Adesh
A
Tandon
D000328:Adult; D000368:Aged; D057785:Catheters; D004574:Electromagnetic Fields; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D055756:Meningeal Carcinomatosis / Q000000981:diagnostic imaging / Q000601:surgery; D008875:Middle Aged; D044582:Neuroendoscopes; D038361:Neuronavigation / Q000379:methods*; D019635:Neurosurgical Procedures / Q000295:instrumentation* / Q000379:methods*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000000981:diagnostic imaging / Q000601:surgery; D012189:Retrospective Studies; D055815:Young Adult
Electromagnetic neuronavigation; Frameless stereotaxy; Neuroendoscopy; Ommaya reservoir; Ventricular catheter