Summary
A 63-year old woman with breast carcinoma developed leucoencephalopathy and local brain necrosis after intraparenchymal infusion of methotrexate. This iatrogenic condition was caused by drain disconnection of the Ommaya device (bore hole type). The diagnosis of this rare complication of an Ommaya device was based on multiplanar MR-imaging. The case is discussed with regard to the complications of intraventricular chemotherapy by means of an Ommaya reservoir.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Ommaya AK: Subcutaneous reservoir and pump for sterile access to ventricular cerebrospinal fluid. Lancet II: 983–984, 1963
Gamache FW, Posner JB, Patterson RH: Metastatic brain tumors, treatment of leptomeningeal metastases. In: Youmans JR (ed) Neurological Surgery. W.B. Saunders Company, Philadelphia 2893–2894, 1982
Bleyer WA, Pizzo PA, Spence AM, Platt WD, Benjamin DR, Kolins J, Poplack DG: The Ommaya reservoir: newly recognized complications and recommendations for insertion and use. Cancer 41: 2431–2437, 1978
Browne MJ, Dinndorf PA, Perek D, Commers J, Bleyer WA, Poplack DG, Pizzo PA: Infectious complications of intraventricular reservoirs in cancer patients. Pediatr Infect Dis J 6: 182–189, 1987
Cheshire WP, Ehle AL: Hemiparkinsonism as a complication of an Ommaya reservoir. J Neurosurg 73: 774–776, 1990
Goedhart ZD: Het Ommaya systeem. Leiden: 1978, thesis
Gribbin MA, Hardisty RM, Chessels JM: Long term control of central nervous system leukemia. Arch Dis Child 7: 123–129, 1977
Jacobs A, Clifford P, Kay HEM: The Ommaya reservoir in chemotherapy for malignant disease in the CNS. Clin Oncol 7: 123–129, 1981
Lemann W, Wiley RG, Posner JB: Leucoencephalopathy complicating intraventricular catheters: clinical, radiographic and pathologic study of 10 cases. J Neuro-Oncol 6: 67–74, 1988
Lishner M, Perrin RG, Feld R, Messner HA, Tuffneil PG, Elhakim T, Matlow A, Curtis JE: Complications associated with Ommaya reservoirs in patients with cancer. Arch Intern Med 150: 173–176, 1990
Obbens EAMT, Leavens ME, Beal JW, Lee YY: Ommaya reservoirs in 387 cancer patients: a 15-year experience. Neurology 35: 1274–1278, 1985
Packer RJ, Zimmerman RA, Rosenstock J, Rorke LB, Norris DG, Berman PH: Focal encephalopathy following methotrexate therapy. Arch Neurol 38: 450–452, 1981
Spiers ASD, Booth AE: Reservoirs for intraventricular chemotherapy. Lancet 1:1263, 1973
Milano G, Thyss A, Serre Debeauvais F, Laureys G, Benoit Y, Deville A, Dutour C, Robert A, Otten J, Behar C, Frappaz D: CSF drug levels for children with Acute Lymphoblasrtic Leukemia treated by 5g/m2 methotrexate. Eur J Cancer 26: 492–495, 1990
Uldry PA, Teta D, Regli L: Nécrose cérébrale focalisée secondaireá une chimiotherapie intraventriculaire au methotrexate. Neurochirurgie 37: 72–74, 1991
Bleyer WA: Neurologic sequelae of methotrexate and ionizing radiation: a new classification. Cancer Treat Rep 65 (suppl. 1): 89–98, 1981
Boogerd W, Hart AAM, Van der Sande JJ, Engelsman E: Meningeal carcinomatosis in breast cancer. Prognostic factors and influence of treatment. Cancer 67: 1685–1695, 1991
Colamaria V, Caraballo R, Borgna-Pignatti C, Marradi P, Balter R, Mazza C, Procacci C, Dalla Bernardina B: Transient focal leucoencephalopathy following intraventricular methotrexate and cytarabine. Childs Nerv Syst 6: 231–235, 1990
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
de Waal, R., Algra, P.R., Heimans, J.J. et al. Methotrexate induced brain necrosis and severe leukoencephalopathy due to disconnection of an Ommaya device. J Neuro-Oncol 15, 269–273 (1993). https://doi.org/10.1007/BF01050074
Issue Date:
DOI: https://doi.org/10.1007/BF01050074