Surprising outcome of ommaya reservoir in treating cystic craniopharyngioma: a retrospective study

Abstract

Background. Surgical removal (gross total or partial removal), radiotherapy and cyst evacuation have all been used individually or in combination to treat cystic craniopharyngioma, although it is unclear which is the best method. Objective. To report the results of treating cystic craniopharyngioma by insertion of an Ommaya reservoir system (ORS) and aspiration of the cyst. Patients and methods. As from 1990, patients admitted to the neurosurgical department at Assiut University Hospital, Egypt, with grossly cystic craniopharyngioma and who had a single cyst and did not have previous surgery were treated by insertion of an ORS and drainage of the cyst. By 2010, 52 patients had received this treatment with the cystic fluid aspirated completely on the day of surgery. The main presenting symptoms were raised intracranial pressure and visual changes with hormonal changes observed in some patients. The minimal follow-up period was 7 years. Results. To our surprise, 38 (73%) patients did not develop any recollection of the cyst and showed significant clinical improvement. The only possible explanation is that the part of the catheter of the ORS, with holes in, has established communication between the cyst and the CSF spaces around it after the collapse of the cyst with no adverse effect on the patient at any time. Ten (19%) patients needed reaspiration every 6 months and four (8%) patients showed rapid recollection of cystic fluid and were treated with intracystic bleomycin. Conclusion. Treatment of cystic craniopharyngioma by drainage through an ORS is very effective. The majority of patients do not need any further treatment. Those who develop re-accumulation of cystic fluid are easily treated by simple aspiration of the fluid through the reservoir. It is a simple and safe method, which lacks the risks associated with surgery or chemotherapy.