About an Ommaya Reservoir: Information for Parents

What is an Ommaya Reservoir?

An Ommaya reservoir is a channel through which fluids can be put into, or removed from, areas in the brain or spinal cord.

It has two parts:
1. a small dome shaped container that is put under the scalp or spine.
2. a small tube (catheter) leading off from the dome.

The end of the tube may be directed into:

  • A cyst in the brain or spinal cord
  • One of the 4 spaces in the brain called “ventricles" The cells in the ventricles produce Cerebral Spinal Fluid (CSF). The CSF flows around the brain and spinal cord to provide a protective cushion. CSF has nutrients that feed the brain.
  • The space in which CSF flows around the spinal cord (subarachnoid space).

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    How is it used?

    Unlike shunts in the brain, the Ommaya reservoir’s main use is not as a drain for fluids causing on-going pressure in the brain (ICP). The Ommaya reservoir is used:

  • To deliver medications, such as chemotherapy drugs, directly into the CSF. This is a way to bathe brain or spinal cord tumours in a powerful, and therefore more effective, form of chemotherapy.
  • To keep draining and treating with medications, brain cysts that cannot be removed surgically.
  • To take samples of CSF for testing.

    Note: Before putting medications into the brain or spinal cord, some CSF may be taken out. For example, if 5ml of medication going in, 5ml of CSF will be taken out. This is done so that medicine going in does not increase pressure in the skull (ICP).

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    How is an Ommaya Reservoir put in?

    The surgeon must position the Ommaya reservoir under the scalp or into the spine and make a small hole through the skull or into the spine for the tubing. S/he can then guide the tube into position.
    The physician will discuss the risks and benefits of this form of treatment with you. If you agree to go ahead with it, you will be asked to sign a consent. The surgeon will schedule a time for the surgery. A consent indicates that you understand the purpose of the treatment and its risks and benefits for your child. Discuss any concerns with the doctor. Make sure you have all of the information you need in order to make an informed decision.

    How is the Ommaya Reservoir used?

    The Ommaya Reservoir can be used as soon as it is in place.
    The doctor will discuss the treatment plan with you.

    Treatments can be done on an outpatient basis in the clinic. While the treatment itself takes about 15 minutes, allow at least 30-60 minutes for each visit, as discussed with your doctor.

    Chemotherapy drugs are put into the dome container by the doctor. Every effort is made to keep the area free of germs. S/he cleans the skin over the reservoir with an antiseptic and then inserts a needle into the dome. Your child may feel a slight prick like a ‘bee-sting' when the needle goes in.

    The doctor may take a little CSF out for testing and to check that the tubing is in the right place.

    The doctor might also remove some CSF to make space and then inject the medication and remove the needle. S/he “pumps" (presses the dome up and down) to push the medication through the tube into the target space.

    Sometimes s/he covers the injection site with a small bandaid.

    After the treatments

    The nurse will check your child closely to make sure that all is well after each treatment. S/he will be watching for complications such as infection, altered neurological status and side effects of the medication.

    Your child can do whatever activities s/he feels like after the treatment. But, sometimes children have a headache for a day or two and may not feel like doing too much. Your doctor or nurse can advise you what to do for this type of headache.

    The physician may teach you how to ‘pump' the reservoir to prevent it from blocking. Only pump the reservoir if your doctor asks you to and has showed you how.

    Caring for the child after the surgery.

    Children are cared for in hospital for at least 24-48 hours after surgery to place an Ommaya reservoir. They must be carefully checked often.

    Checking for early signs of nerve damage.
    The nurse will be waking your child every few hours to make sure there are no signs of bleeding into the brain or spinal cord, pressure on nerves, or CSF leaking. Please let the nurse know about any changes in your child’s behaviour. These may be important. You know your child best and may be the first to see small changes. We respect your opinion about what you observe.

    Keeping the wound and the tubing free from infection.

  • The incision is closed with staples or stitches. The wound may be covered with a dressing for the first 24 hours and then left open to the air unless the doctor wants to keep it covered.
    The nurse will check to see that the incision is healing well.
  • Wash your child’s hair 48 hours after the surgery. The nurse may do the first shampoo with Chlorhexidine (soap that kills germs). At home, wash the hair daily with a gentle shampoo. If your child has dissolvable stitches, rub the wound with a clean washcloth during the shampoo.
  • Brief showers are best until the staples or sutures are out.
    Do not soak the incision in a bath, or allow your child to swim, for at least two weeks after surgery. Check timing with the doctor.
  • Don’t rub any cream around the incision unless the doctor has asked you to treat the area with a specific ointment.

    Check your child and the incision for these signs of infection:
  • Redness, swelling and pain
  • Clear, bloody or pus-like discharge
  • Sores or spots on the skin
  • Wound opening so you see the reservoir
  • Fever
  • Headache or pain in the back or abdomen
  • Behaviour changes such as tiredness, lack of interest in things, crankiness.

    If your child has any of these signs, contact your doctor.
    If your child is very ill, please go at once to an Emergency Room.

    Removing the stitches.
    Your nurse will tell you when the stitches should be taken out (about 10-14 days after surgery). She will show you how to do this. If the surgeon has used dissolvable stitches you do not need to remove them.

    • Protecting the reservoir

    The reservoir is protected by the skin. It is safe, unless it gets a hard bump and/or breaks. If this happens it can cause internal bleeding. Talk to your doctor, before you go home, about what activities may be dangerous for your child.
    It is always best to have your child checked by a doctor if you think that the reservoir may be damaged.

    Contact Numbers:

    Clinic Nurse:_____________________________

    Physician:________________________________

    Clinic Number:____________________________

    At Children's & Women's Health Centre of British Columbia we believe parents are partners on the health care team. We want you to be as informed as possible. This brochure will answer some of your questions. Please ask about things you do not understand and share your concerns.
    If you have any questions, please call : 604-875-2345 local 7678

    2003 / 5 / 1 Developed by the Department of Neurosciences with assistance from the Department of Patient/Family Education PE# 373

     

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