Cystic brain metastasis of non-small-cell lung cancer successfully controlled with Ommaya reservoir placement

Abstract

A 68-year-old male presented with hoarseness and anarthria. Computed tomography showed an irregular nodular shadow in the upper lobe of the left lung with swollen multiple lymph nodes. Magnetic resonance imaging revealed a large cystic mass in the left hemisphere of the brain and multiple brain metastases in the bilateral hemispheres. A direct biopsy with bronchoscopy of the pulmonary nodule revealed the tumor to be an adenocarcinoma clinically diagnosed as stage IV. Since the largest brain metastasis continued to grow despite the administration of whole brain irradiation, insertion of an Ommaya reservoir in the cystic lesion was performed. This resulted in a reduction of the size of the brain tumor, and the patient's neurological symptoms improved. After the Ommaya reservoir was placed, stereotactic radiosurgery was performed on the largest lesion. The patient is doing well at 6 months after the Ommaya reservoir was inserted and is currently undergoing chemotherapy. In conclusion, the placement of an Ommaya reservoir may therefore be a potentially useful therapeutic procedure to improve the neurological symptoms and performance status in non-small-cell lung cancer patients with cystic brain metastasis, thereby allowing further neurosurgical therapy and chemotherapy. © 2012 The Japan Society of Clinical Oncology.