P13.05 Success Rate and Early Morbidity from Image-Guided Ommaya Reservoir Placement for Intraventricular Chemotherapy: Case Series and Systematic Review
Bibliographic record
Abstract
BACKGROUND: Ayub Ommaya proposed a surgical technique for subcutaneous reservoir and pump placement in 1963 in order to allow access to intraventricular cerebrospinal fluid (CSF). Currently, the most common indication for Ommaya reservoir insertion in adults is for patients with hematologic or leptomeningeal disorders requiring repeated injection of chemotherapy into the CSF space. Historically, the intraventricular catheter has been inserted blindly based on anatomical landmarks. The purpose of this study was to compare short-term complication rates from traditional versus image-guided Ommaya reservoir placement. METHODS: We retrospectively evaluated all operative cases of image-guided Ommaya reservoir insertion from 2004–2014 by the senior author (JFM). Patient demographic data, surgical outcomes, and peri-operative complications were collected. A systematic review was performed using Medline and Embase databases using Medical Subject Headings (MeSH) and relevant keywords as regular expressions (1960 to January 2016). The literature search was limited to the English language. Two reviewers independently screened each article title and abstract for relevance to the research question. Disagreements resulted in automatic inclusion. Studies were included if participants were undergoing first-time intraventricular Ommaya reservoir insertion for chemotherapy with no prior cranial operations. Studies that did not report surgical outcome data were excluded. Accurate placement and early (30-day) morbidity or mortality were considered primary outcomes. RESULTS: 28 patients underwent image-guided Ommaya reservoir insertion by the senior author (JFM) over the study period (43.3 +/- 17.3 years; 35.7% female). Indications for placement included acute lymphoblastic leukemia, diffuse large B-cell lymphoma, and leptomeningeal carcinomatosis. There were two complications: one asymptomatic peri-operative intracranial hemorrhage (3.6%), and one early infection (3.6%) requiring catheter removal and intravenous antibiotics. All catheters were accurately placed (100% success rate). The literature search revealed 1659 Embase and 1011 Medline articles for a total of 2670 articles. No randomized controlled trials were identified. Quality of evidence was rated based on the Methodological Index for Non-Randomized Studies (MINORS) score. Data extraction and statistical analysis for the systematic review are in progress. CONCLUSIONS: Our findings suggest improved accuracy and decreased complications using an image-guided approach compared with a traditional approach. Our results support routine use of intra-operative image guidance for proximal catheter insertion in elective Ommaya reservoir placement for intraventricular chemotherapy.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.039 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.005 | 0.005 |
| Bibliometrics | 0.014 | 0.015 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.003 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.006 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".