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Ommaya reservoirs are indicated for administration of intrathecal chemotherapy in the setting of leptomeningeal disease. The standard approach for insertion is a burr hole overlying the frontal horn with fixation of the device flange to the periosteum of the skull for stabilization. However, the dome of the Ommaya using this technique can create a cosmetically unacceptable result for patients with alopecia related to their treatment. Materials and Methods: We describe a simple modification of the standard technique for insertion of Ommaya reservoirs that recesses the flange onto the inner table of the skull and secures the device with small titanium screws. Results: This technique has been used in 18 patients at our institution with cosmetically superior results. However, medical oncologists need to be made aware of the fact that the device is recessed so they can be assured that it is still present and can be used. Conclusions: The recessed Ommaya reservoir technique is an option for the placement of Ommaya reservoirs in patients who will undergo intrathecal therapy. This paper describes a technique that has been used in 18 patients with whom the cosmetic results were felt to be superior. Categories: Neurosurgery

Recession of Ommaya Reservoir Improves Cosmesis in Patients Undergoing Intrathecal Chemotherapy for Leptomeningeal Disease: a Technical Note