- •Foreword
- •Preface
- •Acknowledgments
- •Contents
- •Contributors
- •1.2 Forehead Augmentation
- •1.2.1 Discussion
- •1.3.1 Discussion
- •1.4 Rhinoplasty
- •1.4.1 Discussion
- •1.5 Lip Augmentation
- •1.5.1 Discussion
- •1.6 Chin and Jaw Augmentation
- •1.6.1 Discussion
- •Further Reading
- •Forehead Augmentation
- •Rhinoplasty
- •Lip Augmentation
- •Jaw Augmentation
- •2: Imaging the Postoperative Orbit
- •2.1 Eyelid Weights
- •2.1.1 Discussion
- •2.2 Palpebral Springs
- •2.2.1 Discussion
- •2.3.1 Discussion
- •2.4.1 Discussion
- •2.5.1 Discussion
- •2.6.1 Discussion
- •2.7 Strabismus Surgery
- •2.7.1 Discussion
- •2.8 Glaucoma Surgery
- •2.8.1 Discussion
- •2.9 Scleral Buckles
- •2.9.1 Discussion
- •2.10 Keratoprostheses
- •2.10.1 Discussion
- •2.11 Intraocular Lens Implants
- •2.11.1 Discussion
- •2.12 Surgical Aphakia
- •2.12.1 Discussion
- •2.13 Pneumatic Retinopexy
- •2.13.1 Discussion
- •2.14 Intraocular Silicone Oil
- •2.14.1 Discussion
- •2.15.1 Discussion
- •2.16 Orbital Tissue Expanders
- •2.16.1 Discussion
- •2.17 Orbital Exenteration
- •2.17.1 Discussion
- •2.18.1 Discussion
- •Further Reading
- •Eyelid Weights
- •Palpebral Spring
- •Frontalis Suspension Ptosis Repair
- •Strabismus Surgery
- •Glaucoma Surgery
- •Scleral Buckles
- •Keratoprostheses
- •Intraocular Lens Implants
- •Surgical Aphakia
- •Pneumatic Retinopexy
- •Intraocular Silicone Oil
- •Orbital Tissue Expanders
- •Orbital Exenteration
- •3.1.1 Discussion
- •3.2 Septoplasty
- •3.2.1 Discussion
- •3.3.1 Discussion
- •3.4.1 Discussion
- •3.5 Nasal Packing Material
- •3.5.1 Discussion
- •3.6 Rhinectomy
- •3.6.1 Discussion
- •3.7 Sinus Lift Procedure
- •3.7.1 Discussion
- •3.8 Caldwell-Luc Procedure
- •3.8.1 Discussion
- •3.9 External Ethmoidectomy
- •3.9.1 Discussion
- •3.10.1 Discussion
- •3.11 FESS Complications
- •3.11.1 Discussion
- •3.11.2 Discussion
- •3.11.3 Discussion
- •3.11.4 Discussion
- •3.11.5 Discussion
- •3.11.6 Discussion
- •3.11.7 Discussion
- •3.11.8 Discussion
- •3.11.9 Discussion
- •3.11.10 Discussion
- •3.11.11 Discussion
- •3.12 Osteoplastic Flap with Frontal Sinus Obliteration
- •3.12.1 Discussion
- •3.13 Frontal Sinus Cranialization
- •3.13.1 Discussion
- •3.14 Paranasal Sinus Stents
- •3.14.1 Discussion
- •3.15 Frontal Sinus Trephination
- •3.15.1 Discussion
- •3.16.1 Discussion
- •3.17.1 Discussion
- •3.18 Maxillary Swing
- •3.18.1 Discussion
- •Further Reading
- •Septoplasty
- •Nasal Septal Button Prosthesis
- •Nasal Packing Material
- •Rhinectomy
- •Sinus Lift
- •Caldwell-Luc Procedure
- •External Ethmoidectomy
- •Functional Endoscopic Sinus Surgery
- •FESS Complications
- •Osteoplastic Flap with Frontal Sinus Obliteration
- •Frontal Sinus Cranialization
- •Paranasal Sinus Stents
- •Frontal Sinus Trephination
- •Maxillectomy and Palatectomy
- •Maxillary Swing
- •4.1 Occipital Nerve Stimulator
- •4.1.1 Discussion
- •4.2 Tissue Expander
- •4.2.1 Discussion
- •4.3 Temporal Fossa Implants
- •4.3.1 Discussion
- •4.4.1 Discussion
- •4.5.1 Discussion
- •4.6.1 Discussion
- •4.7 Scalp Tumor Recurrence
- •4.7.1 Discussion
- •4.8 Burr Holes
- •4.8.1 Discussion
- •4.9 Craniotomy
- •4.9.1 Discussion
- •4.10 Cranioplasty
- •4.10.1 Discussion
- •4.11 Autocranioplasty
- •4.11.1 Discussion
- •4.12.1 Discussion
- •4.14.1 Discussion
- •4.15 Box Osteotomy
- •4.16.1 Discussion
- •4.17.1 Discussion
- •4.18.1 Discussion
- •4.19 Subdural Drainage Catheters
- •4.19.1 Discussion
- •4.20.1 Tension Pneumocephalus
- •4.20.5 Pseudomeningoceles
- •4.20.6 Pseudoaneurysm
- •4.20.7 Postoperative Infection
- •4.20.8 Textiloma
- •4.20.9 Sunken Skin Flap Syndrome
- •4.20.10 External Brain Herniation
- •4.20.11 Bone Flap Resorption
- •Further Reading
- •Occipital Nerve Stimulator
- •Tissue Expander
- •Temporal Fossa Implant
- •Scalp Tumor Recurrence
- •Box Osteotomy
- •Absorbable Hemostatic Agents
- •Duraplasty and Sealant Agents
- •Burr Holes
- •Craniotomy
- •Cranioplasty
- •Autocranioplasty
- •Cranial Vault Reconstruction for Craniosynostosis
- •Cranial Vault Encephalocele Repair
- •Subdural Drainage Catheters
- •Intracranial Pressure Monitor
- •Cranial Surgery Complications
- •5.1 Intraoperative MRI
- •5.1.1 Discussion
- •5.2.1 Stereotactic Biopsy
- •5.2.1.1 Discussion
- •5.2.2 Resection Cavities
- •5.2.2.1 Discussion
- •5.2.3 Ommaya Reservoirs
- •5.2.3.1 Discussion
- •5.2.4 Chemotherapy Wafers
- •5.2.4.1 Discussion
- •5.2.5 Brachytherapy Seeds
- •5.2.5.1 Discussion
- •5.2.6.1 Discussion
- •5.3.1 Prefrontal Lobotomy
- •5.3.1.1 Discussion
- •5.3.2 Pallidotomy
- •5.3.2.1 Discussion
- •5.3.3 Cingulotomy
- •5.3.3.1 Discussion
- •5.3.4.1 Discussion
- •5.3.4.2 Thalamotomy
- •5.3.5 Deep Brain Stimulation (DBS)
- •5.3.5.1 Discussion
- •5.3.6.1 Discussion
- •5.3.7.1 Discussion
- •5.3.8.1 Discussion
- •5.3.9.1 Discussion
- •5.3.10 Corticectomy
- •5.3.10.1 Discussion
- •5.3.11.1 Discussion
- •5.3.12.1 Discussion
- •5.3.13 Callosotomy
- •5.3.13.1 Discussion
- •5.3.14 Anterior Temporal Lobectomy
- •5.3.14.1 Discussion
- •5.3.15.1 Discussion
- •5.3.16 Hemispherectomy
- •5.3.16.1 Discussion
- •Further Reading
- •Intraoperative MRI
- •Brain Tumor Surgery
- •Stereotactic Biopsy
- •Resection Cavities
- •Postoperative Hemorrhagic Lesions
- •Ommaya Reservoirs
- •Chemotherapy Wafers
- •Brachytherapy Seeds
- •GliaSite Radiation Therapy System
- •Prefrontal Lobotomy
- •Pallidotomy
- •Cingulotomy
- •Thalamotomy
- •Deep Brain Stimulation (DBS)
- •Epidural Motor Cortex Stimulator
- •Neural Interface System (BrainGate)
- •Corticectomy
- •Selective Disconnection
- •Callosotomy
- •Anterior Temporal Lobectomy
- •Hemispherectomy
- •6.1 Types of Procedures
- •6.1.1 External Ventricular Drainage
- •6.1.1.1 Discussion
- •6.1.2.1 Discussion
- •6.1.3 Atypical Ventricular Shunts
- •6.1.3.1 Discussion
- •6.1.4 Ventriculosubgaleal Shunts
- •6.1.4.1 Discussion
- •6.1.5.1 Discussion
- •6.1.6.1 Discussion
- •6.1.7 Subdural-Peritoneal Shunts
- •6.1.7.1 Discussion
- •6.1.8.1 Discussion
- •6.1.9.1 Discussion
- •6.1.10 Lumboperitoneal Shunts
- •6.1.10.1 Discussion
- •6.1.11 Third Ventriculocisternostomy
- •6.1.11.1 Discussion
- •6.1.12.1 Discussion
- •6.1.13 Aqueductoplasty
- •6.1.13.1 Discussion
- •6.1.14.1 Discussion
- •6.2.1.1 Discussion
- •6.2.2.1 Discussion
- •6.2.3 Intraventricular Fat Migration
- •6.2.3.1 Discussion
- •6.2.4.1 Discussion
- •6.2.5.1 Discussion
- •6.2.6 Slit Ventricle Syndrome
- •6.2.6.1 Discussion
- •6.2.7.1 Discussion
- •6.2.8 Shunt-Associated Infections
- •6.2.8.1 Discussion
- •6.2.9.1 Discussion
- •6.2.10.1 Discussion
- •6.2.11.1 Discussion
- •6.2.12 Peritoneal Pseudocysts
- •6.2.12.1 Discussion
- •6.2.13.1 Discussion
- •6.2.14 Tumor Seeding
- •6.2.14.1 Discussion
- •6.2.15 Shunt Catheter Calcification
- •6.2.15.1 Discussion
- •6.2.16.1 Discussion
- •6.2.17.1 Discussion
- •Further Reading
- •Types of Procedures
- •External Ventricular Drainage
- •Ventriculoperitoneal Shunts
- •Atypical Ventricular Shunts
- •Ventriculosubgaleal Shunts
- •Subdural-Peritoneal Shunts
- •Lumboperitoneal Shunt
- •Third Ventriculostomy
- •Aqueductoplasty
- •Fourth Ventricular Stenting
- •Complications
- •Intraventricular Fat Migration
- •Slit Ventricle Syndrome
- •Shunt-Associated Infections
- •Shunt Malposition and Migration
- •Pseudocysts
- •Cerebrospinal Fluid Leak Syndrome
- •Tumor Seeding
- •Shunt Catheter Calcifications
- •7.1.1 Discussion
- •7.2.1 Discussion
- •7.3.1 Discussion
- •7.4.1 Discussion
- •7.5.1 Discussion
- •7.6.1 Discussion
- •7.7 Radiosurgery for Vestibular Schwannomas
- •7.7.1 Discussion
- •Further Reading
- •Anterior Craniofacial Resection
- •Transsphenoidal Resection
- •Middle Cranial Fossa Reconstruction
- •Surgical Approaches for Vestibular Schwannoma Resection
- •8.1.1 Discussion
- •8.2 Auriculectomy
- •8.2.1 Discussion
- •8.3 Auricular Reconstruction
- •8.3.1 Discussion
- •8.4.1 Discussion
- •8.5 Atresiaplasty
- •8.5.1 Discussion
- •8.6.1 Discussion
- •8.7.1 Discussion
- •8.8 Ossicular Interposition
- •8.8.1 Discussion
- •8.9.1 Discussion
- •8.10.1 Discussion
- •8.11.1 Discussion
- •8.12 Atticotomy
- •8.12.1 Discussion
- •8.13.1 Discussion
- •8.14.1 Discussion
- •8.15.1 Discussion
- •8.16 Temporal Bone Resection
- •8.16.1 Discussion
- •8.17 Cochlear Implants
- •8.17.1 Discussion
- •8.18.1 Discussion
- •8.19.1 Discussion
- •8.20.1 Discussion
- •8.21.1 Discussion
- •8.22 Labyrinthectomy
- •8.22.1 Discussion
- •8.23 Vestibular Nerve Section
- •8.23.1 Discussion
- •8.24.1 Discussion
- •8.25.1 Discussion
- •Further Reading
- •BAHA Device
- •Auriculectomy
- •Auricular Reconstruction
- •Canaloplasty and Meatoplasty
- •Atresiaplasty
- •Myringoplasty and Tympanoplasty
- •Incus Interposition
- •Ossicular Prosthesis Complications
- •Transcanal Atticotomy
- •Mastoidectomy Complications
- •Lateral Temporal Bone Resection
- •Cochlear Implants
- •Cochlear Implant Complications
- •Auditory Brainstem Stimulator
- •Repair of Perilymphatic Fistula
- •Labyrinthectomy
- •Vestibular Nerve Sectioning
- •Tube Drainage of Cholesterol Cysts
- •9.1 Vertical Ramus Osteotomy
- •9.1.1 Discussion
- •9.2 Sagittal Split Osteotomy
- •9.2.1 Discussion
- •9.3 Genioplasty
- •9.3.1 Discussion
- •9.4.1 Discussion
- •9.5 Mandibular Distraction
- •9.5.1 Discussion
- •9.6 LeFort I Osteotomy
- •9.6.1 Discussion
- •9.7 LeFort III Osteotomy
- •9.7.1 Discussion
- •9.8.1 Discussion
- •9.9 Mandibulotomy
- •9.9.1 Discussion
- •9.10 Enucleation
- •9.10.1 Discussion
- •9.11 Cyst Decompression
- •9.11.1 Discussion
- •9.12 Coronoidectomy
- •9.12.1 Discussion
- •9.13.1 Discussion
- •9.14.1 Discussion
- •9.15.1 Discussion
- •9.16.1 Discussion
- •9.17.1 Discussion
- •9.18.1 Discussion
- •9.19.1 Discussion
- •9.20.1 Discussion
- •Further Reading
- •Vertical Ramus Osteotomy
- •Sagittal Split Osteotomy
- •Genioplasty
- •Mandibular Angle Augmentation
- •Mandibular Distraction
- •Lefort I Surgery
- •Lefort III Surgery
- •Fixation of Mandible Fractures
- •Mandibulotomy
- •Enucleation
- •Cyst Decompression
- •Coronoidectomy
- •Eminectomy and Meniscal Plication
- •10: Imaging the Postoperative Neck
- •10.1 Reconstruction Flaps
- •10.1.1 Discussion
- •10.2 Neck Dissection
- •10.2.1 Discussion
- •10.3 Parotidectomy
- •10.3.1 Discussion
- •10.4.1 Discussion
- •10.5 Facial Reanimation
- •10.5.1 Discussion
- •10.6.1 Discussion
- •10.7.1 Discussion
- •10.8 Transoral Robotic Surgery
- •10.8.1 Discussion
- •10.9 Sistrunk Procedure
- •10.9.1 Discussion
- •10.10 Laryngectomy
- •10.10.1 Discussion
- •10.11.1 Discussion
- •10.12 Montgomery T-Tubes
- •10.12.1 Discussion
- •10.13 Salivary Bypass Stent
- •10.13.1 Discussion
- •10.14 Laryngeal Stents
- •10.14.1 Discussion
- •10.15.1 Discussion
- •10.16 Arytenoid Adduction
- •10.16.1 Discussion
- •10.17 Arytenoidectomy
- •10.17.1 Discussion
- •10.18 Laryngeal Cartilage Remodeling
- •10.18.1 Discussion
- •10.19 Tracheotomy
- •10.19.1 Discussion
- •10.20 Thyroidectomy
- •10.20.1 Discussion
- •10.21.1 Discussion
- •10.22 Brachytherapy
- •10.22.1 Discussion
- •10.23 Vagal Nerve Stimulation
- •10.23.1 Discussion
- •Further Reading
- •Reconstruction Flaps
- •Facial Reanimation
- •Tonsillectomy and Adenoidectomy
- •Transoral Robotic Surgery
- •Neck Dissection
- •Parotidectomy
- •Salivary Duct Stenting
- •Laryngectomy
- •Montgomery T-Tubes
- •Salivary Bypass Stents
- •Laryngeal Stents
- •Arytenoid Adduction
- •Arytenoidectomy
- •Laryngeal Cartilage Remodeling
- •Tracheotomy
- •Thyroidectomy
- •Neck Exploration and Parathyroidectomy
- •Sistrunk Procedure
- •Brachytherapy
- •Vagal Nerve Stimulation
- •11: Imaging of Postoperative Spine
- •11.1 Overview
- •11.2 Spine Decompression
- •11.2.1.1 Discussion
- •11.2.2 Laminectomy
- •11.2.2.1 Discussion
- •11.2.3 Facetectomy
- •11.2.3.1 Discussion
- •11.2.4 Microdiscectomy
- •11.2.4.1 Discussion
- •11.2.5 Laminoplasty
- •11.2.5.1 Discussion
- •11.2.6 Vertebrectomy
- •11.2.6.1 Discussion
- •11.2.7 Cordectomy
- •11.2.7.1 Discussion
- •11.3.1 Halo and Traction Devices
- •11.3.1.1 Discussion
- •11.3.2 Bone Graft Materials
- •11.3.2.1 Discussion
- •11.3.3 Implantable Bone Stimulators
- •11.3.3.1 Discussion
- •11.3.4 Odontoid Screw Fixation
- •11.3.4.1 Discussion
- •11.3.5 Occipitocervical Fusion
- •11.3.5.1 Discussion
- •11.3.6 Anterior Cervical Fusion
- •11.3.6.1 Discussion
- •11.3.7.1 Discussion
- •11.3.8 Posterior Fusion
- •11.3.8.1 Discussion
- •11.3.9 Scoliosis Rods
- •11.3.9.1 Discussion
- •11.3.10 Vertebral Stapling
- •11.3.10.1 Discussion
- •11.3.11 Vertical Expandable Prosthetic Titanium Rib (VEPTR)
- •11.3.11.1 Discussion
- •11.3.12 Interbody Fusion
- •11.3.12.1 Discussion
- •11.4.1 Total Disc Replacement
- •11.4.1.1 Discussion
- •11.4.2.1 Discussion
- •11.4.3.1 Discussion
- •11.4.4 Dynamic Facet Replacement
- •11.4.4.1 Discussion
- •11.4.5 Dynamic Rods
- •11.4.5.1 Discussion
- •11.5.1 Overview
- •11.5.2.1 Discussion
- •11.5.3.1 Discussion
- •11.5.4.1 Discussion
- •11.5.5 Cerebrospinal Fluid Leak
- •11.5.5.1 Discussion
- •11.5.6.1 Discussion
- •11.5.7 Surgical Site Infections
- •11.5.7.1 Discussion
- •11.5.8 Postoperative Neuritis
- •11.5.8.1 Discussion
- •11.5.9 Arachnoiditis
- •11.5.9.1 Discussion
- •11.5.10.1 Discussion
- •11.5.11 Postoperative Synovial Cyst
- •11.5.11.1 Discussion
- •11.5.12 Residual/Recurrent Tumors
- •11.5.12.1 Discussion
- •11.5.13 Inclusion Cysts
- •11.5.13.1 Discussion
- •11.5.14.1 Discussion
- •11.5.15 Retained Surgical Tools
- •11.5.15.1 Discussion
- •11.5.16 Gossypiboma
- •11.5.16.1 Discussion
- •11.5.17.1 Discussion
- •11.5.18 Postoperative Deformity
- •11.5.18.1 Discussion
- •11.6.1 Discussion
- •11.7 Spinal Cord Stimulators
- •11.7.1 Discussion
- •11.8 Filum Terminale Sectioning
- •11.8.1 Discussion
- •11.9.1 Vertebral Augmentation
- •11.9.1.1 Discussion
- •11.9.2 Kiva Device
- •11.9.2.1 Discussion
- •11.9.3 Sacroplasty
- •11.9.3.1 Discussion
- •11.9.4.1 Discussion
- •11.9.5.1 Discussion
- •11.9.6.1 Discussion
- •Further Reading
- •Overview
- •Laminectomy
- •Facetectomy
- •Microdiscectomy
- •Laminoplasty
- •Vertebrectomy
- •Cordectomy
- •Bone Graft Materials
- •Implantable Bone Stimulators
- •Odontoid Screw Fixation
- •Anterior Cervical Fusion
- •Posterior Fusion
- •Occiptiocervical Fusion
- •Scoliosis Rods
- •Vertebral Stapling
- •Interbody Fusion
- •Nucleus Pulposus Replacement
- •Dynamic Facet Replacement
- •Dynamic Rods
- •Cerebrospinal Fluid Leak
- •Seromas and Hematomas
- •Postoperative Infection
- •Postoperative Neuritis
- •Arachnoiditis
- •Postoperative Synovial Cyst
- •Residual/Recurrent Tumors
- •Inclusion Cysts
- •Retained Surgical Tools
- •Gossypiboma
- •Postoperative Deformity
- •Intrathecal Spinal Infusion Pump
- •Spinal Cord Stimulators
- •Filum Terminale Sectioning
- •Kiva Device
- •Sacroplasty
- •Percutaneous Spine Fusion
- •CT-Guided Epidural Blood Patch
- •12.1 Vascular Surgery
- •12.1.1.1 Discussion
- •12.1.2.1 Discussion
- •12.1.3.1 Discussion
- •12.1.4.1 Discussion
- •12.1.6.1 Discussion
- •12.1.7 Carotid Endarterectomy
- •12.1.7.1 Discussion
- •12.1.8 Carotid Body Stimulation
- •12.1.8.1 Discussion
- •12.1.9 Adjustable Vascular Clamp
- •12.1.9.1 Discussion
- •12.1.10.1 Discussion
- •12.2 Endovascular Surgery
- •12.2.7 Endovascular Reconstructive Treatment for Acute Ischemic Stroke Using Intra-arterial Thrombolysis or Embolectomy
- •12.2.10 Endovascular Stent Reconstructive Treatment for Extracranial Cerebrovascular Occlusive Disease
- •12.2.11 Endovascular Reconstructive Treatment for Active Extracranial Hemorrhage or Pseudoaneurysm
- •Further Reading
- •Vascular Surgery
- •Aneurysm and Hemostatic Ligation Clips
- •Intracranial Aneurysm Muscle Wrap
- •Vascular Malformation Surgery
- •Carotid Endarterectomy
- •Carotid Body Stimulation
- •Adjustable Vascular Clamp
- •Reconstruction of the Great Vessels
- •Endovascular Surgery
- •General Imaging Considerations Following Endovascular Cerebrovascular Procedures
- •Endovascular Treatment for Aneurysms
- •Endovascular Stent Reconstructive Treatment for Extracranial Cerebrovascular Occlusive Disease
- •Endovascular Reconstructive Treatment for Active Extracranial Hemorrhage or Pseudoaneurysm
- •Endovascular Treatment for Intracranial Venous Stenosis and Occlusion
- •Index
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5.2.3\ Ommaya Reservoirs
5.2.3.1\ Discussion
Intrathecal chemotherapy can lengthen survival and alleviate symptoms in patients with widespread leptomeningeal metastases. The two primary means of delivering intrathecal chemotherapy are Ommaya reservoirs and repeat lumbar puncture. Ommaya reservoirs are implanted in the subcutaneous tissues of the scalp and contain a pump mechanism for drug delivery agents into the ventricular system through an intraventricular catheter (Fig. 5.24). Ommaya reservoirs offer many advantages over repeat lumbar punctures, including greater patient comfort, diminished risk for patients with thrombocytopenia, more consistent drug levels, and possibly greater clinical efficacy. Tumor cyst devices are similar to Ommaya shunts, but are used to inject chemotherapeutic agents directly into tumors.
Infection is a major complication of Ommaya catheter placement. The incidence of Ommaya- associated infection is 15% within the first year of placement (range 2–23%). Staphylococcus aureus and Staphylococcus epidermidis are the most common causative organisms. Manifestations of catheter-associated infection range from meningitis to abscess, for which imaging is useful for identifying fluid collections surrounding the catheter (Fig. 5.25). Debris in the fluid and enhancement helps differentiate infection from hygromas
(simple fluid collections), which can also occur with Ommaya catheter placement. Management consists of antibiotic therapy and possible hardware removal and debridement depending on the extent of the infection.
Focal brain necrosis due to chemotherapy extravasation secondary to Ommaya reservoir catheter obstruction is rare, with an incidence of 0.6% of patients. This condition is caused by displacement of the catheter tip into the brain parenchyma. Imaging demonstrates circumferential areas of necrosis surrounding the retracted Ommaya catheter, manifesting as patchy enhancement, high T2 signal, and restricted diffusion, representing cytotoxic edema (Fig. 5.26). A unique and serious complication of methotrexate extravasation is progressive leukoencephalopathy. This entity involves the white matter diffusely and can be either hemorrhagic or nonhemorrhagic.
Cerebrospinal fluid cysts can sometimes form around Ommaya catheters and may be caused by distal shunt obstruction, although this complication can also occur when the catheter is appropriately positioned, with or without hydrocephalus. The pericatheter cysts do not have perceptible walls or rim enhancement, but may have surrounding edema. Although the cysts may be asymptomatic, it is important to evaluate for predisposing factors that could be addressed, such as malpositioning of the Ommaya catheter (Fig. 5.27).
5 Imaging the Intraoperative and Postoperative Brain |
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a |
b |
c
Fig. 5.24 Ommaya reservoir components. The patient has a history of leptomeningeal spread of breast cancer. Axial CT images show the Ommaya reservoir (arrow) positioned in the right frontal subcutaneous tissues (a). The drug delivery catheter enters the intracranial compart-
ment via a burr hole. The tip of the catheter lies within the anterior horn of the left lateral ventricle (b). 3D CT image (c) shows the reservoir (arrows) and catheter entering the skull through a burr hole
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d |
Fig. 5.25 Ommaya catheter infection. The patient presented with exposed Ommaya reservoir hardware and cellulitis. Axial CT image (a) shows a left parietal Ommaya catheter surrounded by a fluid collection (arrow), which is difficult to discern amidst streak artifact. Axial
T2-weighted (b), T1-weighted (c), and post-contrast T1-weighted (d) MR images show a complex fluid collection with rim enhancement surrounding the Ommaya catheter, compatible with a pericatheter abscess
5 Imaging the Intraoperative and Postoperative Brain |
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a |
b |
c
Fig. 5.26 Extravasation of methotrexate through blocked Ommaya reservoir with focal brain necrosis. Post-contrast sagittal T1-weighted MRI (a) shows edema and patchy enhancement surrounding the catheter. Axial FLAIR (c)
better delineates the extent edema surrounding the Ommaya catheter, and the corresponding ADC map (c) shows restricted diffusion surrounding the path of the Ommaya catheter, consistent with cytotoxic edema
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Fig. 5.27 Ommaya catheter-associated cyst and catheter malpositioning (a) shows a right frontal lobe periventricular cerebrospinal fluid cyst (encircled). Axial T1-weighted
MRI (b) shows the catheter (arrow) has penetrated the right basal ganglia instead of the lateral ventricle. There is also hydrocephalus