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2017 ; 9
(7
): e1490
Nephropedia Template TP
Cureus
2017[Jul]; 9
(7
): e1490
PMID28944129
show ga
Ommaya reservoir placement has been an option for patients requiring
cerebrospinal fluid (CSF) access since the 1960s. It is preferred to repeat
lumbar punctures, both in terms of patient comfort and the consistency of
intrathecal drug concentration. Technological developments have advanced the
placement technique, allowing for better accuracy and reduced complications.
Freehand placement was first augmented with pneumoencephalograms and
intraoperative computerized tomography (CT), then with optical-based navigation,
and finally by utilizing electromagnetic neuronavigation. We outline a method of
placement using electromagnetic neuronavigation and intraoperative endoscopic
visualization, which allows for both real-time guidance and the confirmation of
placement while maintaining tract patency for the entirety of the procedure. We
make our incision and burr hole near Kocher's point. The neuronavigation stylet
is placed in a peel-away sheath (Cook Medical, Bloomington, Indiana, US), which
allows us to advance into the ventricle under real-time neuronavigation guidance.
After the ventricle is entered, the stylet may be withdrawn and an endoscope
advanced down the sheath. The intraventricular anatomy and catheter placement are
confirmed. The burr hole reservoir is attached to a ventricle catheter that has
been trimmed based on trajectory measurement on preoperative imaging. The
reservoir-catheter construct can then be placed and the sheath removed from
around it. This method provides a high level of confidence in appropriate
catheter placement.