Subcutaneous Cerebrospinal Fluid Reservoirs in Patients with Acute Leukaemia

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Abstract
S.c. CSF (Ommaya) reservoirs were inserted in 23 patients with acute leukemia and 2 patients with malignant lymphoma. In 9 leukemia patients reservoirs were used for the prophylaxis of CNS leukemia: only 1 patient developed meningeal leukemia, but less invasive therapy achieves effective prophylaxis and prophylactic use of Ommaya reservoirs was discontinued. In 16 patients, reservoirs were inserted as aids to the treatment of meningeal leukemia or lymphoma. Intracranial disease was successfully controlled and recurrences were prevented but patients eventually died from relapse of their systemic disease. The principal complications of the s.c. reservoirs were obstruction, misplacement and 1 case of infection. Leukoencephalopathy in several patients was attributable to irradiation and cytotoxic drugs and not to the reservoirs. Problems due to misplacement of the reservoir occurred in 3 out of 13 reservoirs inserted by the occipital route and in only 1 of 12 reservoirs inserted by a frontal approach. With adequate supervision, the reservoirs are valuable aids to intrathecal therapy in patients with established meningeal leukemia or lymphoma.