Ommaya Reservoir System for the Treatment of Cystic Craniopharyngiomas: Surgical Results in a Series of 11 Adult Patients and Review of the Literature

Objective: Treatment of cystic craniopharyngiomas can be challenging and recurrences are frequent, even after total resection. In selected cases, less-aggressive surgery with the sole drainage of the cyst reliefs symptoms caused by mass effect and represents a valid alternative option, notably in pediatric population. We herein analyze a series of adult cystic craniopharyngiomas, managed with Ommaya Reservoir implant, focusing on local tumor control and eventual complications. Methods: In total, 11 nonconsecutive adult cystic craniopharyngiomas (7 recurrent lesions) were treated with Ommaya Reservoir System (ORS), in 2 neurosurgical centers. ORS was placed in 9 cases using minimally invasive procedures: 6 burr-hole endoscopic insertion and 3 navigated electromagnetic placement; in the remaining 2 patients, the Ommaya reservoir was used as a shunt to prevent cyst recollection during a transcranial approach. Results: The main presenting symptoms were visual impairment (75%), cognitive and behavioral disorders (66.7%), hypopituitarism (38%), headache (30.8%), and hypothalamic obesity (8%). The median follow-up period was 41.4 months. In all patients, the visual function and intracranial hypertension improved after decompression. Local tumor control was accomplished in 8 patients (72.7%), without the need of adjuvant treatments. The endoscopic vision carried similar rates of tumor control than stereotaxy (75% vs. 66.7%). Conclusions: In selected patients, tailored procedures are required to achieve long-term tumor control and as well limit surgery-related morbidity. ORS could represent a safe and effective treatment option for cystic craniopharyngiomas, providing also reduced surgical-related morbidity, especially in recurrent lesions and in patients not suitable for radical surgery.