Cystic Craniopharyngiomas Treated by Ommaya Reservoir Implantation About 4 Cases Including 2 Cases of Intracystic Injection of Bleomycin

Abstract

<i>Introduction. </i>Cystic craniopharyngiomas are the most common form of craniopharyngiomas. The treatment is still debated. The less aggressive and multidisciplinary approach is more recommended. <i>Methods. </i>We describe 4 cases of cystic craniopharyngiomas managed in our department by implantation of an Ommaya reservoir. The diagnosis was retained on imaging and in front of the appearance of the cyst puncture fluid. Intracystic chemotherapy with bleomycin was performed in 2 cases. <i>Results. </i>Patient’s age was 3, 34, 51 and 65 years. There were 2 female and 2 male patients. Clinical signs were dominated by headache (4 cases) and visual disturbances (4 cases). The Ommaya reservoir was placed with an endoscope in 2 cases. Postoperative insipid diabetes was noted in these 2 cases. A puncture of the Ommaya reservoir was performed on average every 3 weeks (2 cases) in the absence of Bleomycin. Infection was noted in these 2 cases. The evolution was favorable in 3 cases including the 2 cases of Bleomycin injection. <i>Conclusion. </i>Ommaya reservoir implantation was a satisfactory alternative to surgical excision of craniopharyngiomas. The use of the endoscope increased the risk of developing insipid diabetes. Close punctures of the reservoir increased the risk of infection. Intra-cystic Bleomycin stopped the punctures of the reservoir.