The Experts below are selected from a list of 303 Experts worldwide ranked by ideXlab platform
Willam Gump - One of the best experts on this subject based on the ideXlab platform.
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Use of Ommaya Reservoir with a Thoracic Spinal Catheter for Intrathecal Delivery of Nusinersen in a Patient with Spinal Muscular Atrophy Type 2 (P4.464)
Neurology, 2018Co-Authors: Arpita Lakhotia, Sonam Bhalla, Elizabeth Doll, Willam GumpAbstract:Objective: To demonstrate use of Ommaya Reservoir as a means to provide intrathecal delivery of nusinersen in a patient with Spinal Muscular Atrophy Type 2 (SMA2) where lumbar puncture was not feasible due to extensive spinal fusion. Background: Nusinersen is an antisense oligonucleotide approved for all forms of Spinal Muscular Atrophy (SMA). Patients with SMA develop neuromuscular scoliosis, and tend to have spinal fusion with spinal rods for correction of scoliosis. This has posed a challenge towards administration of intrathecal nusinersen, since drug delivery via lumbar puncture is often difficult. The Ommaya Reservoir is an intraventricular catheter system used to deliver drugs into the cerebrospinal fluid. We demonstrate use of Ommaya Reservoir with intrathoracic catheter for intrathecal nusinersen delivery. Design/Methods: Chart Review Results: A 20-year-old female with SMA2 presented for initiation of nusinersen therapy. She had neuromuscular scoliosis with spinal fusion and two posterior spinal rods extending from upper thoracic to lower lumbar spine. After discussion with interventional neuroradiologists and neurosurgeons, it was determined that lumbar puncture under interventional radiology guidance would be futile due to the extent of spinal fusion. Decision was made to place an Ommaya Reservoir connected to the spine for delivery of medication intrathecally. A thoracic laminectomy was performed, and bony window created. A soft intrathecal catheter was introduced into the subarachnoid space via a durotomy within the spinal fusion segments. The Ommaya Reservoir was placed subcutaneously in-between scapulae and connected to intrathecal catheter. Procedure was tolerated well, and first dose of nusinersen was injected approximately three weeks after surgery. Patient has completed all loading doses with no complications related to the Ommaya Reservoir. Conclusions: An off-label use of the Ommaya Reservoir with an intrathecal catheter connected to the thoracic spinal canal, is a viable and safe option to deliver intrathecal nusinersen for patients who have extensive spinal fusion and instrumentation. Disclosure: Dr. Lakhotia has nothing to disclose. Dr Bhalla has nothing to disclose. Dr. Doll has nothing to disclose. Dr. Gump has nothing to disclose.
Suresh K. Mukherji - One of the best experts on this subject based on the ideXlab platform.
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Leukoencephalopathy complicating an Ommaya Reservoir and chemotherapy.
Neuroradiology, 1999Co-Authors: Jeffrey A. Stone, Mauricio Castillo, Suresh K. MukherjiAbstract:We describe the imaging findings in an unusual case of biopsy-proven, methotrexate-induced leukoencephalopathy complicating a malfunctioning Ommaya Reservoir in a patient with lymphoma.
Mark Bernstein - One of the best experts on this subject based on the ideXlab platform.
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Modified stereotactic insertion of the Ommaya Reservoir. Technical note
Journal of neurosurgery, 2000Co-Authors: Abdul Al-anazi, Mark BernsteinAbstract:Ommaya Reservoirs are used primarily for the repeated injection of intrathecal chemotherapy for leptomeningeal metastasis from hematopoietic and solid malignancies. Insertion of this device in a relatively large nondisplaced ventricle is not a difficult task, but challenges arise when the ventricle is small and/or displaced. Different techniques have been developed to overcome this difficulty, most of which include the use of stereotactic frames. Further improvements would be beneficial. The technique described in this paper depends on a stereotactic frame; however, the modification proposed by the authors removes the arc system from the surgical field before the actual surgical procedure is begun. Removal of the arc improves access to the surgical field as well as preparation and draping of the surgical site and minimizes potential breaks in sterile technique, which ultimately reduces the incidence of infection. A twist-drill hole along the path of the chosen trajectory becomes an external guide for the ventricular catheter. The technique is easy, user friendly, and results in an unencumbered sterile field and reliable cannulation of small ventricles. A simple stereotactic technique for Ommaya Reservoir insertion has been described. It should lower the chance of infection in this group of patients, most of whom have suppressed immune systems.
Gang Zhao - One of the best experts on this subject based on the ideXlab platform.
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Application of the Ommaya Reservoir in Managing Ventricular Hemorrhage.
World neurosurgery, 2015Co-Authors: Xi-tao Yang, Dong-fu Feng, Liang Zhao, Zhao-liang Sun, Gang ZhaoAbstract:Background Intraventricular hemorrhage (IVH) is associated with high morbidity and mortality. This study evaluated the safety and efficacy of the combined treatment of an Ommaya Reservoir and conventional external ventricular drainage (EVD) using urokinase in the management of IVH. Methods We performed a prospective controlled study. Sixty eligible patients with IVH received conventional EVD alone (group A) or combined EVD and Ommaya Reservoir (group B) between January 2010 and January 2015. Clinical, cerebrospinal fluid, and radiographic data were used to assess clot clearance, clinical outcomes, and complications between the groups. Results There were no significant differences in gender, age, blood pressure, Glasgow Coma Scale, Graeb score, intracerebral hemorrhage volume on admission, and IVH volume before surgery between groups A and B ( P > 0.05). The number of injections of urokinase (20,000 IU/dose) were significantly different in group B compared with group A ( P P P P P > 0.05). The hydrocephalus incidence and mortality revealed significant differences between the 2 groups ( P P Conclusions The combined treatment approach of an Ommaya Reservoir and EVD with intraventricular urokinase is safe and effective in patients with IVH. It increased clot clearance, shortened conventional catheter-based EVD duration, prolonged total drainage time, reduced the hydrocephalus incidence and mortality, and contributed to good clinical outcomes. The Ommaya Reservoir provides a safe way to increase the injection times of urokinase, which accelerated clot resolution and did not increase the risk for ventriculitis infection.
G Barnett - One of the best experts on this subject based on the ideXlab platform.
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Percutaneous aspiration of brain tumor cysts via the Ommaya Reservoir system.
Neurology, 1991Co-Authors: L R Rogers, G BarnettAbstract:We performed percutaneous aspiration of 21 brain tumor cysts in 20 patients using the Ommaya Reservoir system. Ages ranged from 3 to 70 years, median 48. Sixteen were primary tumors (12 anaplastic glioma, 2 craniopharyngioma, 1 oligodendroglioma, 1 brainstem glioma) and 4 were metastatic. Fourteen had the CT appearance of a true cyst and 7 a pseudocyst. We placed 18 catheters through twist drill holes via CT stereotactic guidance and 3 through burr holes via CT guidance and effectively aspirated 3 to 50 ml cyst fluid from 1 to 18 times in each patient. Postaspiration CT showed complete or significant reduction in cyst size in all patients in whom it was performed (18 after initial aspiration and 9 after subsequent aspirations). Asymptomatic intracyst hemorrhage occurred in 2 patients after cyst wall biopsy and catheter placement. There have been no other complications at follow-up of 4 to 114 weeks. In our experience, tumor cyst aspiration by the Ommaya Reservoir system is as effective as percutaneous needle aspiration, but after catheter placement aspiration can be performed with minimal technical skill, avoiding repeated CT guidance required for needle aspiration of recurrent deep-seated cysts.
