LONG-TERM ACCESS TO CYSTIC BRAIN-STEM LESIONS USING THE OMMAYA RESERVOIR - TECHNICAL CASE-REPORT

OBJECTIVE AND IMPORTANCE: Unresectable cystic brain stem lesions are o ften responsible for neurological dysfunction. Stereo tactic aspiratio n of such lesions can lead to clinical improvement, but cyst recurrenc e is common and multiple aspirations may be necessary. CLINICAL PRESEN TATION: Three children with unresectable cystic brain stem lesions wer e treated at the University of Florida. Two patients initially underwe nt stereotactic biopsy and cystic aspiration, both improving after cys tic decompression, Both patients returned 3 months later with symptoma tic cyst recurrences requiring further intervention. Six years after s urgical resection of a posterior fossa medulloblastoma, the third pati ent presented with a dorsal midbrain cyst. INTERVENTION: All three pat ients had catheters placed into the cyst cavities under stereotactic g uidance. A subcutaneous Ommaya reservoir was attached to the existing catheter. In the event of symptomatic cyst recurrence, the Ommaya rese rvoir ran be tapped in an outpatient setting. CONCLUSION: Cystic decom pression resulted in clinical improvement in all three children. Multi ple aspirations were necessary in two patients for symptomatic cyst re currences. The Ommaya reservoir allows for cyst aspiration in an outpa tient setting and avoids multiple stereotactic manipulations. This sys tem may also be used to instill radioisotopes or it may be converted t o a cyst-peritoneal shunt if multiple aspirations fail to achieve cyst ic control.