Chamberlain M C, Kormanik P A, Barba D
Department of Neurosciences, University of California at San Diego, 92093-8421, USA.
J Neurosurg. 1997 Nov;87(5):694-9. doi: 10.3171/jns.1997.87.5.0694.
The authors studied complications associated with intraventricular chemotherapy in patients with leptomeningeal metastases (LM). One hundred twenty consecutive patients with LM (71 females and 49 males) ranging in age from 10 to 72 years (median 42 years) were treated with involved-field radiotherapy and intraventricular chemotherapy using an Ommaya reservoir and intraventricular catheter system. The diagnosis of LM was determined by a combination of clinical presentation (114 patients); cerebrospinal fluid cytological studies (100); or neuroradiographic studies (42). Systemic tumor histological findings included breast (34 patients); non-Hodgkin's lymphoma (22); melanoma (16); primitive neuroectodermal tumors including medulloblastoma (10); glial neoplasms, leukemia, small cell lung, nonsmall cell lung, and colon (six each); prostate and kidney (three each); and gastric cancers (two). Sixteen patients, all with non-Hodgkin's lymphoma, also had acquired immune deficiency syndrome. Patients received one to four (median two) chemotherapeutic drugs and underwent a total of 1110 cycles of intraventricular chemotherapy (median 10). Intraventricular chemotherapy administration and diagnostic Ommaya reservoir punctures totaled 4400, with a median of 46 per patient. Complications included aseptic/chemical meningitis (52 patients); myelosuppression due to intraventricular chemotherapy (21); catheter-related infections (nine); unidirectional catheter obstruction (six); intraventricular catheter malpositioning (two); Ommaya reservoir exposure (two); leukoencephalopathy (two); and chemotherapy-related myelopathy (one). There were no treatment-related deaths; however, seven patients (6%) required additional surgery for either catheter repositioning (two) or reservoir removal (five). Seven patients with catheter-related infections were treated successfully with intraventricular and systemic antibiotic drugs, thereby preserving the Ommaya system. The authors conclude that Ommaya reservoirs are convenient and pharmacologically rational systems for administering intraventricular chemotherapy. Overall, serious complications requiring surgery are infrequent (6%) and most often secondary to catheter infections, Ommaya reservoir exposure, or initial catheter malpositioning. In the majority of instances, catheter infections may be managed medically, as may the most common complications of intraventricular chemotherapy including aseptic meningitis (43% of patients) and myelosuppression (18%).
作者研究了柔脑膜转移（LM）患者脑室内化疗相关的并发症。连续120例LM患者（71例女性和49例男性），年龄10至72岁（中位年龄42岁），接受了累及野放疗及使用Ommaya储液器和脑室内导管系统进行的脑室内化疗。LM的诊断通过临床表现（114例患者）、脑脊液细胞学检查（100例）或神经影像学检查（42例）综合判定。全身肿瘤组织学检查结果包括乳腺癌（34例患者）、非霍奇金淋巴瘤（22例）、黑色素瘤（16例）、包括髓母细胞瘤在内的原始神经外胚层肿瘤（10例）、神经胶质瘤、白血病、小细胞肺癌、非小细胞肺癌和结肠癌（各6例）、前列腺癌和肾癌（各3例）以及胃癌（2例）。16例患者均为非霍奇金淋巴瘤，还患有获得性免疫缺陷综合征。患者接受了1至4种（中位2种）化疗药物，共进行了1110个周期的脑室内化疗（中位10个周期）。脑室内化疗给药及诊断性Ommaya储液器穿刺共计4400次，每位患者中位穿刺次数为46次。并发症包括无菌性/化学性脑膜炎（52例患者）、脑室内化疗导致的骨髓抑制（21例）、导管相关感染（9例）、单向导管阻塞（6例）、脑室内导管位置不当（2例）、Ommaya储液器外露（2例）、白质脑病（2例）以及化疗相关脊髓病（1例）。无治疗相关死亡；然而，7例患者（6%）因导管重新定位（2例）或储液器移除（5例）需要额外手术。7例导管相关感染患者通过脑室内及全身使用抗生素药物成功治疗，从而保留了Ommaya系统。作者得出结论，Ommaya储液器是用于脑室内化疗给药的方便且药理学合理的系统。总体而言，需要手术的严重并发症并不常见（6%），且大多继发于导管感染、Ommaya储液器外露或初始导管位置不当。在大多数情况下，导管感染及脑室内化疗最常见的并发症包括无菌性脑膜炎（43%的患者）和骨髓抑制（18%）可以通过药物治疗。
