About Your Surgery
This guide will help you prepare for your surgery to have your Ommaya reservoir placed. For the rest of this resource, our use of the words “you” and “your” refer to you or your child.
An Ommaya reservoir is a quarter-sized, soft, plastic, dome-shaped device that is placed under the scalp. The reservoir is connected to a catheter (thin, flexible tube) that is placed into your brain, in one of your ventricles (see Figures 1 and 2).
Figure 1. Ommaya reservoir
Figure 2. Placement of the Ommaya reservoir
An Ommaya reservoir will help your doctor or nurse practitioner:
- Get samples of cerebrospinal fluid (CSF). CSF is the fluid that surrounds your brain and spinal cord. It is made in your ventricles. Your doctor or nurse practitioner can check your CSF for cancer cells in your spinal fluid and infections in the lining around your brain.
- Give you medication, such as chemotherapy, monoclonal antibodies, or antibiotics directly into your CSF.
These procedures are referred to as an “Ommaya reservoir tap.” You may need fewer spinal taps, if you have an Ommaya reservoir.
The surgery to place your Ommaya reservoir is done in the operating room while you are asleep. Once you are asleep, the hair along your incision line will be shaved. Your entire head will not be shaved.
Your neurosurgeon will make a C-shaped incision (surgical cut) behind your hairline. He or she will insert the reservoir dome under your scalp. Your neurosurgeon will pass the catheter through your brain into the space where CSF forms. He or she will close your incision with sutures (stitches).
The surgery will take about 1 hour.
The surgery to place your Ommaya reservoir can cause some complications. These complications are
- There is a small risk that you could bleed into your brain.
- There is a small risk that you could have some loss of function. Your neurosurgeon will talk with you about this risk.
- There is a small risk that you could get an infection in your brain. To reduce the risk of infection, you will be given antibiotics after your surgery.
- Your Ommaya reservoir may need to be adjusted. To make sure it is in the right place, you will get a computed tomography (CT) scan the day after your surgery. If your reservoir is not in the right place, you may need to have another surgery to fix it.
- Your Ommaya reservoir may not work. To make sure your Ommaya reservoir is working, a CSF flow study may be done after your surgery. If you need a CSF flow study, your doctor or nurse will give you more information about this.
Your neurosurgeon will explain all the possible risks and complications before your surgery.Back to top
Before Your Surgery
The information in this section will help you prepare for your surgery. Read through this section when your surgery is scheduled and refer to it as your surgery date gets closer. It contains important information about what you need to do before your surgery. Write down any questions you have and be sure to ask your doctor or nurse.
You and your healthcare team will work together to prepare for your surgery.
About Drinking Alcohol
The amount of alcohol you drink can affect you during and after your surgery. It is important that you talk with your healthcare providers about your alcohol intake so that we can plan your care.
- Stopping alcohol suddenly can cause seizures, delirium, and death. If we know you are at risk for these complications, we can prescribe medication to help prevent them.
- If you drink alcohol regularly, you may be at risk for other complications during and after surgery. These include bleeding, infections, heart problems, greater dependence on nursing care, and longer hospital stay.
Here are things you can do to prevent problems before your surgery:
- Be honest with your healthcare provider about how much alcohol you drink.
- Try to stop drinking alcohol once your surgery is planned. If you develop a headache, nausea, increased anxiety, or cannot sleep after you stop drinking, tell your doctor right away. These are early signs of alcohol withdrawal and can be treated.
- Tell your healthcare provider if you cannot stop drinking.
- Ask us any questions you have about drinking and surgery. As always, all of your treatment information will be kept confidential.
Help us keep you safe during your surgery by telling us if any of the following statements apply to you, even if you aren’t sure.
- I take a blood thinner. Some examples are heparin, warfarin (Coumadin®), clopidogrel (Plavix®), and tinzaparin (Innohep®). There are others, so be sure your doctor knows all the medications you’re taking.
- I take prescription medications.
- I take any over-the-counter medications, herbs, vitamins, minerals, or natural or home remedies.
- I have a pacemaker, automatic implantable cardioverter-defibrillator (AICD), or other heart device.
- I have sleep apnea.
- I have had a problem with anesthesia in the past.
- I have allergies, including to latex.
- I am not willing to receive a blood transfusion.
- I drink alcohol.
- I smoke.
- I use recreational drugs.
People who smoke can have breathing problems and a higher risk of getting an infection when they have surgery. Smoking also slows would healing and increases the chance of problems with your reconstruction. Stopping even for a few days before surgery can help. If you smoke, your nurse will refer you to our Tobacco Treatment Program. You can also reach the program at 212-610-0507.
About Sleep Apnea
Sleep apnea is a common breathing disorder that causes a person to stop breathing for short periods while sleeping. The most common type is obstructive sleep apnea (OSA). This means that the airway becomes completely blocked during sleep, so no air can get through. OSA can cause serious problems when you have surgery. Please tell us if you have sleep apnea or if you think you might have it. If you use a breathing machine (such as a CPAP) for sleep apnea, bring it with you the day of your surgery.
You will have a presurgical testing appointment before your surgery. Depending on your age, your testing can take place in different locations. The date, time, and location of your PST appointment will be printed on the appointment reminder from your surgeon’s office.
You can eat and take your usual medications the day of your presurgical testing appointment. During your appointment, you will meet with a nurse practitioner who works closely with anesthesiology staff (doctors and specialized nurses who give you medication to sleep during your surgery) and your surgeon.
Your nurse practitioner will review your medical and surgical history with you, including your medications, herbal supplements, and vitamins. He or she will review the details of your surgery with you and what to expect after. You will be asked to sign a consent form for your surgery. You may have tests, including an electrocardiogram (EKG) to check your heart rhythm, a chest x-ray, blood tests, and any other tests necessary to plan your care. You may also have magnetic resonance imaging (MRI) or a computed tomography (CT) scan for treatment planning before your surgery. Your nurse practitioner may refer you to other healthcare providers such as a child life specialist or social worker.
Your nurse practitioner will talk with you about which medications you should take the morning of your surgery. To help you remember, we’ve left space for you to write these medications down in “The Morning of Your Surgery” section of this guide.
A financial counselor will also be available to meet with you and discuss any insurance issues. Please bring all of your insurance information.
Please bring the following with you to your presurgical testing appointment:
- A list of all the medications you are taking, including patches and creams.
- Results of any tests done outside of MSK, such as a cardiac stress test, echocardiogram (echo), or carotid doppler study.
- Your insurance card.
- The name(s) and telephone number(s) of your doctor(s).
Please be aware that your presurgical testing appoinment may take serveral hours.
Parking at the PDH
The PDH is located at the main hospital.
1275 York Avenue (between East 67th and East 68th Streets)
New York, NY 10065
Take the B elevator to the 9th floor
Parking at the main hospital is available in the garage on East 66th Street between York and First Avenues. To reach the garage, enter East 66th Street from York Avenue. The garage is located about a quarter of a block in from York Avenue, on the right-hand (north) side of the street. There is a pedestrian tunnel that goes from the garage into the hospital. If you have questions about prices, call 212-639-2338.
There are also other garages located on East 69th Street between First and Second Avenues, East 67th Street between York and First Avenues, and East 65th Street between First and Second Avenues.
Parking at PST
PST is located in the Rockefeller Outpatient Pavilion, also known as MSK 53rd Street.
Rockefeller Outpatient Pavilion
160 East 53rd Street (at Third Avenue)
New York, NY 10022
There are several options for parking during your PST appointment. The Bristol Garage offers discounts to patients. To receive the discount, have your parking ticket validated at the concierge desk in the Rockefeller Outpatient Pavilion. There is a shuttle that goes from the Bristol Garage to the Rockefeller Outpatient Pavilion every 20 minutes.
The Bristol Garage
300 East 56th Street (between First and Second Avenues)
New York, NY 10022
There are additional parking garages located at East 53rd Street between Second and Third Avenues and East 54th Street between Second and Third Avenues.
The Ronald McDonald House provides temporary housing for out-of-town pediatric cancer patients and their families.
MSK also has arrangements with several local hotels and housing facilities that may give you a special reduced rate. Your social worker can discuss your options and make reservations.
Tell Us if You’re Sick
If you develop any illness before your surgery, call the doctor who scheduled your surgery. This includes a fever, cold, sore throat, or the flu.
Stop Taking Certain Medications
If you take vitamin E, stop taking it 10 days before your surgery. If you take aspirin, ask your surgeon whether you should continue. Medications such as aspirin, medications that contain aspirin, and vitamin E can cause bleeding. For more information, please read Common Medications Containing Aspirin and Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs), located in this section.
Stop Taking Herbal Remedies and Supplements
Stop taking herbal remedies or supplements 7 days before your surgery. If you take a multivitamin, talk with your doctor or nurse about whether you should continue. For more information, please read Herbal Remedies and Cancer Treatment, located in this section.
Stop taking nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (e.g., Advil®, Motrin®) and naproxen (e.g. Aleve®). These medications can cause bleeding. For more information, please read Common Medications Containing Aspirin and Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs), located in this section.
Note the Time of Your Surgery
A staff member will call you after 2:00 pm the day before your surgery. He or she will tell you what time you should arrive at the hospital for your surgery. If you are scheduled for surgery on a Monday, you will be called on the Friday before. If you do not receive a call by 4:00 pm, please call 212-639-7056.
- Pediatric Day Hospital (PDH)
B elevator to 9th floor
- Presurgical Center (PSC)
B elevator to 6th floor
Both locations are at 1275 York Avenue between East 67th and East 68th streets.
Unless you are given other instructions, you can shower and wash your hair.
Do not apply any hair products such as hair spray or hair gel.
Go to bed early and get a full night’s sleep.
Nothing by mouth (NPO) guidelines require that you not eat or drink anything for a certain amount of time before your surgery. This exact period of time is based on your age and any other medical problems that you may have. Your nurse practitioner will talk with you about what you can and cannot eat before surgery.
If you do not follow the NPO guidelines, your surgery may be cancelled.
Write down your NPO guidelines
Take Your Medications
If your doctor or nurse practitioner instructed you to take certain medications the morning of your surgery, take only those medications with a sip of water. Do not take any medications 2 hours before your surgery.
Write down which medications you should take the morning of your surgery.
Things to Remember
- Wear loose clothing.
- Do not put on any lotions, creams, deodorants, makeup, powders, or perfumes.
- Do not wear any metal objects. Remove all jewelry, including body piercings. The equipment used during your surgery can cause burns if it touches metal.
- Leave valuables, such as credit cards, jewelry, or your checkbook at home.
- Before you are taken into the operating room, you will need to remove your eyeglasses, hearing aids, dentures, prosthetic device(s), wig, and religious articles, such as a rosary.
- If you wear contact lenses, wear your glasses instead.
- Only the money you may need for a newspaper, bus, taxi, or parking.
- Your portable music player, if you choose. However, someone will need to hold this item for you when you go into surgery.
- Your incentive spirometer, if you have one.
- Your breathing machine for sleep apnea (such as your CPAP), if you have one.
- If you have a case for your personal items, such as eyeglasses, hearing aid(s), dentures, prosthetic device(s), wig, and religious articles such as a rosary, bring it with you.
- Your Health Care Proxy form, if you have completed one.
- This guide. Your healthcare team will use this guide to teach you how to care for yourself after your surgery.
Parking When You Arrive
Parking at MSK is available in the garage on East 66th Street between York and First Avenues. To reach the garage, enter East 66th Street from York Avenue. The garage is located about a quarter of a block in from York Avenue, on the right-hand (north) side of the street. There is a pedestrian tunnel that connects the garage to the hospital. If you have questions about prices, call 212-639-2338.
There are also other garages located on East 69th Street between First and Second Avenues, East 67th Street between York and First Avenues, and East 65th Street between First and Second Avenues.
Once You’re in the Hospital
Tell Us Who You Are
You will be asked to state and spell your name and date of birth many times. This is for your safety. People with the same or similar name may be having surgery on the same day.
Get Dressed for Surgery
You will be given a hospital gown, robe, and nonskid socks.
Meet With Your Nurse
Your nurse will meet with you before your surgery. Tell him or her the dose of any medications (including patches and creams) you took after midnight and the time you took them.
Meet With Your Anesthesiologist
He or she will:
- Review your medical history with you.
- Talk with you about your comfort and safety during your surgery.
- Talk with you about the kind of anesthesia you will receive.
- Answer any questions you may have about your anesthesia.
Tell your anesthesiologist if you or any of your family members have ever had a problem with anesthesia.
Prepare for Surgery
When it is time for your surgery, your family members will be shown to the waiting area. Your visitors should read Information for Family and Friends for the Day of Surgery, located in this section.
Before you enter the operating room (OR), you will be brought into the OR holding area. A family member can be with you at all times. You will be greeted by a nurse who will make sure that you are comfortable. You will also see your surgeon in the OR holding area. He or she will be able to answer any last minute questions you may have.
You will then be brought into the operating room.
During your surgery, you will receive medication through your IV, MediPort®, or central line. The medication will make you feel drowsy and control your pain. You will not feel any pain during your surgery
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After Your Surgery
The information in this section will tell you what to expect after your surgery, both during your hospital stay and after you leave the hospital. You will learn how to safely recover from your surgery. Write down any questions you have and be sure to ask your doctor or nurse.
When you wake up after your surgery, you will be taken to the Post Anesthesia Recovery Unit (PACU). You may have a special mask over your face with air coming out, which will help you wake up after surgery. You will be attached to machines that monitor your vital signs (body temperature, heart rate, blood pressure, and oxygen level). It is normal to feel tired after surgery. Your PACU nurse will make sure you are comfortable and answer all of your questions. As soon as you are settled in the PACU, a nurse will bring your family members in to be with you.
Once your anesthesia has worn off, you will be taken to your hospital room. Depending on your age and condition, you may be taken to the Pediatric Intensive Care Unit (PICU), the Adult Intensive Care Unit (ICU), or the Neurology Observation Unit (NOU) for close observation and monitoring. After 24 hours, you will most likely be taken to the pediatric or neurology floor for continued care.
You may have a dressing over your incisions. Your doctor will take this off 24 hours after your surgery. Your incision will be left uncovered. You will be asked to move your arms, fingers, toes and legs. Your nurse will check your pupils with a flashlight and ask questions such as “What is your name?”
Will I have pain after my surgery?
Your may have a mild headache or feel discomfort from your incision lines for the first few days after your surgery. Your nurse will give you pain medication. Please tell your nurse if the medication is not helping your pain.
How long will I be in the hospital?
Most people are in the hospital for 1 night after having an Ommaya reservoir placed but this will depend on how fast you recover.
Can family and friends visit me in the hospital?
Your parents, family members, and friends are welcome to visit you during your hospital stay as long as they are in good health. No one with any signs of sickness, such as fever, cough, congestion, sore throat, or rash, is allowed to visit.
Since visiting hours may vary depending on where you will be staying, please check with your nurse regarding the visitation policy. Visitors on the Pediatric Unit are limited to parents, legal guardians, or spouses, and 2 other visitors per day.
Parents, legal guardians, or spouses can call the inpatient unit at any time. Ask your nurse for the phone number. Because of privacy concerns, staff will only give information to parents, legal guardians, or spouses.
Please tell friends and other relatives not to call the inpatient unit for information.
Will I be able to eat and drink?
You will be allowed to drink fluids a few hours after your surgery. Your diet will advance with each meal.
When will my stitches be removed?
The stitches on your scalp will be removed 7 to 14 days after your surgery.
How do I care for my incision?
Mild swelling around the incision is normal. As your incision heals, it may burn, itch, or feel numb.
Do not apply any creams, ointments, hair products, or use a hair dryer on your incisions until they are completely healed. This may take about 6 weeks.
Once your incision is healed, it does not need to be covered. However, you should protect it from the sun by wearing a hat or scarf and using sunblock.
When can I shower?
You can shower 5 days after your surgery. When you wash your hair, use a gentle shampoo, such as baby shampoo.
Do not let your incision soak in water. Avoid baths, hot tubs, and swimming pools for at least 2 weeks after your surgery.
When can I go back to work?
Your doctor will tell you when you can go back to work. This depends on your age, type of work, medical condition, and other factors.
When can I go back to school?
You can go back to school as soon as you feel ready. Tell your school nurse that you have an Ommaya reservoir.
Are there any restrictions on my activities with an Ommaya reservoir?
You will not be able to participate in gym class or play contact sports (i.e., football, boxing, wrestling) for at least 2 weeks after your Ommaya reservoir is placed. Some people may need to wait 6 weeks or longer. This gives you scar time to heal. Talk with your doctor about how long you need to wait.
When your doctor tells you that you can participate in gym class and play contact sports, remember to wear a helmet, if needed. This reduces your risk of getting a head injury.
When can I swim?
Do not swim for at least 2 weeks after your surgery. If your incisions need more time to heal, you may need to wait longer. Your neurosurgeon or nurse practitioner will tell you when it’s okay to swim at your first follow-up appointment after your surgery.
When can I travel?
Do not travel on an airplane until your neurosurgeon says it’s okay.
When is my first appointment after my surgery?
Your first appointment after surgery will be in 7 to 14 days after you leave the hospital. Contact your neurosurgeon’s office to schedule your appointment before you leave the hospital.
Depending on how you are healing, some or all of your stitches will be removed during this appointment.
Will I need any more tests?
You will have a computed tomography (CT) scan within 24 hours after your surgery to make sure your Ommaya reservoir is in the right place.
How do I care for my Ommaya reservoir?
Your Ommaya reservoir does not need special care. You can wash your hair as usual.
Can the Ommaya reservoir be removed?
The reservoir is usually not removed unless you have complications with it.
What if I have other questions?
If you have any questions or concerns, please talk with your doctor or nurse. You can reach them Monday through Friday from 9:00 am to 5:00 pm at the numbers listed below.
After 5:00 pm, during the weekend, and on holidays, call 212-639-2000 and ask for the doctor on call for your doctor.
- Tenderness, redness, or swelling around your reservoir
- Clear, bloody, or pus-like discharge from your reservoir
- A temperature of 100.4° F (38° C) or higher
- Neck stiffness
- Blurry vision
This section contains a list of MSK support services, as well as the resources that were referred to throughout this guide. These resources will help you prepare for your surgery and recover safely. Write down any questions you have and be sure to ask your doctor or nurse.