J Korean Neurosurg Soc.  2024 Jul;67(4):467-476. 10.3340/jkns.2023.0178.

Clinical Safety and Efficiency of the H-Port for Treatment of Leptomeningeal Metastasis

• Jang SM
• Gwak HS
• Kwon JW
• Shin SH
• Yoo H

• KMID: 2556744
• DOI: http://doi.org/10.3340/jkns.2023.0178

Abstract

Objective
: To evaluate the usefulness of a cranial implantable chemoport, the H-port, as an alternative to the Ommaya reservoir for intraventricular chemotherapy/cerebrospinal fluid (CSF) access in patients with leptomeningeal metastasis (LM).
Methods
: One hundred fifty-two consecutive patients with a diagnosis of LM and who underwent H-port installation between 2015 and 2021 were evaluated. Adverse events associated with installation and intraventricular chemotherapy, and the rate of increased intracranial pressure (ICP) control via the port were evaluated for safety and efficacy. These indices were compared with published data of Ommaya (n=89), from our institution.
Results
: Time-to-install and installation-related complications of intracranial hemorrhage (n=2) and catheter malposition (n=5) were not significantly different between the two groups. Intraventricular chemotherapy-related complications of CSF leakage occurred more frequently in the Ommaya than in the H-port group (13/89 vs. 3/152, respectively, p<0.001). Intracranial hemorrhage during chemotherapy occurred only in the Ommaya group (n=4). The CSF infection rate was not statistically different between groups (14/152 vs. 12/89, respectively). The ICP control rate according to reservoir type revealed a significantly higher ICP control rate with the H-port (40/67), compared with the Ommaya result (12/58, p<0.001). Analyzing the ICP control rate based on the CSF drainage method, continuous extraventricular drainage (implemented only with the H-port), found a significantly higher ICP control rate than with intermittent CSF drainage (33/40 vs. 6/56, respectively, p<0.0001).
Conclusion
: The H-port for intraventricular chemotherapy in patients with LM was superior for ICP control; it had equal or lower complication rates than the Ommaya reservoir.

Keyword

Chemoport; Intraventricular chemotherapy; Leptomeningeal metastasis; Ommaya reservoir

Figure

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  Fig. 1. Photographs of H-port and installation process. The composition (A) and dimension of H-port (B), and that of Ommaya reservoir for comparison (C), operative side view of burrhole and side outlet port connected to ventricular catheter (D), and photo takne from above of periosteal apron closure (E).

• 

  Fig. 2. Medical illustration of H-port used for continuous extraventricular drainage of cerebrospinal fluid drawn by medical illustrator.

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