Neuroendoscopic placement of Ommaya reservoir into a cystic craniopharyngioma.
BACKGROUND
Total removal of the tumor is the most acceptable therapeutic modality in the management of craniopharyngioma; however, there are innumerable factors that can upset treatment plans. Unresectable lesions are often treated with gamma knife surgery (GKS). Reduction of the cystic volume is necessary, to decrease the area to be treated with GKS. An Ommaya reservoir system is usually placed during open surgery or by stereotactic access.


METHODS
The authors use a neuroendoscope for safer and less invasive placement of the Ommaya reservoir into deep-seated cystic lesions. The cystic component is aspirated, and the Ommaya reservoir tube is precisely guided and placed into the cyst cavity under neuroendoscopic control with a newly developed two-burr-hole technique. This neuroendoscopic procedure could make it easier to reduce cystic volume prior to GKS as the final procedure. This technique may also be used for instillation of chemotherapeutic agents and for repeat aspirations, making the achievement of cystic control more likely. This type of neuroendoscopic management is a safe and effective procedure and could be considered as an alternative management technique for some stubborn cystic craniopharyngiomas.
Joki
Tatsuhiro
T
Department of Neurosurgery, Jikei University, School of Medicine, 3-25-8 Nishi-Shinbashi Minato-ku, Tokyo 105-8461, Japan. joki@jikei.ac.jp
Oi
Shizuo
S
Babapour
Baback
B
Kaito
Nobuyoshi
N
Ohashi
Kazuyoshi
K
Ebara
Masaki
M
Kato
Masataka
M
Abe
Toshiaki
T
D002404:Catheterization / Q000379:methods; D002648:Child; D003397:Craniopharyngioma / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery*; D004724:Endoscopy; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D009364:Neoplasm Recurrence, Local; D019635:Neurosurgical Procedures / Q000379:methods; D010911:Pituitary Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery*; D011859:Radiography; D013396:Suction / Q000379:methods