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

Frio, Federico; Solari, Domenico; Cavallo, Luigi Maria; Cappabianca, Paolo; Raverot, Gérald; Jouanneau, Emmanuel

doi:10.1016/j.wneu.2019.07.217

Cited by 33 publications

(32 citation statements)

References 30 publications

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“…-The use of intraoperative technologies such as image guidance may help in redoing endonasal approaches where the classical landmarks have been removed. -The use of radiotherapy or radiosurgery [117,134] and of intracystic agents [132] should be discussed in a multidisciplinary meeting and should be considered with cystic lesions, progression of the residual tumor, or, in cases, of tumor recurrence if no further surgery is possible [59,173].…”

Section: Evidencementioning

confidence: 99%

Surgical management of craniopharyngiomas in adult patients: a systematic review and consensus statement on behalf of the EANS skull base section

Cossu

Jouanneau

Cavallo³

et al. 2020

Acta Neurochir

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Background and objective Craniopharyngiomas are locally aggressive neuroepithelial tumors infiltrating nearby critical neurovascular structures. The majority of published surgical series deal with childhood-onset craniopharyngiomas, while the optimal surgical management for adult-onset tumors remains unclear. The aim of this paper is to summarize the main principles defining the surgical strategy for the management of craniopharyngiomas in adult patients through an extensive systematic literature review in order to formulate a series of recommendations. Material and methods The MEDLINE database was systematically reviewed (January 1970-February 2019) to identify pertinent articles dealing with the surgical management of adult-onset craniopharyngiomas. A summary of literature evidence was proposed after discussion within the EANS skull base section. Results The EANS task force formulated 13 recommendations and 4 suggestions. Treatment of these patients should be performed in tertiary referral centers. The endonasal approach is presently recommended for midline craniopharyngiomas because of the improved GTR and superior endocrinological and visual outcomes. The rate of CSF leak has strongly diminished with the use of the multilayer reconstruction technique. Transcranial approaches are recommended for tumors presenting lateral extensions or purely intraventricular. Independent of the technique, a maximal but hypothalamic-sparing resection should be performed to limit the occurrence of postoperative hypothalamic syndromes and metabolic complications. Similar principles should also be applied This article is part of the Topical Collection on Pituitaries

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Section: Evidencementioning

confidence: 99%

Surgical management of craniopharyngiomas in adult patients: a systematic review and consensus statement on behalf of the EANS skull base section

Cossu

Jouanneau

Cavallo³

et al. 2020

Acta Neurochir

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“…Though a few reports of chemical meningitis are known to occur, it is not a common occurrence ( 58 , 59 ). An Ommaya reservoir may be placed ( 60 , 61 ), and instillation of chemotherapy (interferon-alpha) into the cyst may be undertaken for local disease control, if considered appropriate in young children ( 62 , 63 ). Proponents of this type of therapy favor it, as surgical intervention (either by a trans-cranial or an endonasal trans-sphenoidal approach), has been shown to have a higher rate of postoperative endocrinological disturbances than minimally invasive techniques such as the Ommaya reservoir insertion and cyst aspiration/intracystic therapy ( 64 ).…”

Section: Discussionmentioning

confidence: 99%

Intraventricular Craniopharyngiomas—Overcoming Their Relative Inaccessibility: Institutional Experience With a Review of Literature

et al. 2021

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Introduction: Craniopharyngiomas constitute 2–4% of intracranial neoplasms. Intraventricular craniopharyngiomas (IVCrs) are the rarely encountered varieties of these lesions.Objective: The objective of the study was to study the special features in clinical presentation, imaging, management, and surgical outcome of IVCrs.Materials and Methods: This retrospective analysis included the combined experience from two tertiary care institutions. Medical records of histopathologically proven cases of IVCrs from January 1994 to June 2021 were assessed, and images were analyzed based on the criteria by Migliore et al. for inclusion of solely intraventricular lesion with the third ventricular ependyma demarcating it from the suprasellar cistern.Results: Among the 25 patients included (mean age: 35.4 years), the most common presentation included headache (n = 21, 84%), vomiting and other features of raised ICP (n = 18, 72%), visual complaints (n = 12, 48%), and endocrinopathies (n = 11, 44%). Fifteen had predominantly cystic tumors, two were purely solid, and eight were of mixed consistency. Primary open microsurgical procedures were performed in 18 (72%) patients, of which four (16%) were endoscope-assisted. Seven (28%) underwent a purely endoscopic procedure. One underwent a staged surgery with endoscopic cyst fenestration and intracystic interferon (IFN)-alpha therapy, followed by microsurgical excision. Complete excision was achieved in 10 patients, near-total in nine, and partial excision in six. Four patients underwent a ventriculoperitoneal shunt (one before the definitive procedure). At a median follow-up of 36 months (range:11–147 months), five patients developed a recurrence, and one had a stable small residue. This patient and two others with small cystic recurrences were observed. One patient was managed with radiotherapy alone. Another underwent re-surgery after a trial of radiotherapy, and the last patient developed a local recurrence, which was managed with radiotherapy; he then later developed an intraparenchymal recurrence, which was operated.Conclusion: Purely IVCrs present with raised intracranial pressure, and visual disturbances are less common. Their deep-seated location and limited surgical field-of-view makes minimally invasive endoscopic-assisted surgery most suitable for their excision. The thin-walled cystic lesions may be occasionally adherent to the ependymal wall in close vicinity to the thalamus–hypothalamus complex, making complete excision difficult. Their responsiveness to radiotherapy, often leads to a gratifying long-term outcome.

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“…Placement of an Ommaya reservoir enabled repeated cyst drainage until local control is obtained by radiotherapy. In an analysis of 11 adult patients with cystic craniopharyngioma, Frio et al concluded that use of the Ommaya reservoir could reduce surgeryrelated morbidity [18]. After aspiration, visual function was improved.…”

Section: Discussionmentioning

confidence: 99%

Dosimetric and volumetric outcomes of combining cyst puncture through an Ommaya reservoir with index-optimized hypofractionated stereotactic radiotherapy in the treatment of craniopharyngioma

Laville

Capel

Maroote

et al. 2020

Clinical and Translational Radiation Oncology

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

Cited by 33 publications

References 30 publications

Surgical management of craniopharyngiomas in adult patients: a systematic review and consensus statement on behalf of the EANS skull base section

Surgical management of craniopharyngiomas in adult patients: a systematic review and consensus statement on behalf of the EANS skull base section

Intraventricular Craniopharyngiomas—Overcoming Their Relative Inaccessibility: Institutional Experience With a Review of Literature

Dosimetric and volumetric outcomes of combining cyst puncture through an Ommaya reservoir with index-optimized hypofractionated stereotactic radiotherapy in the treatment of craniopharyngioma

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