Background: The management options for cystic craniopharyngioma (CP) are controversial. Surgical resection (gross or partial), radiotherapy, chemotherapy, cyst aspiration, and Ommaya reservoir system (ORS) implantations are the options for management that are used individually or in combination, but the ideal treatment is unclear.Objective: We aimed to investigate the functional outcomes and the complications of Ommaya reservoir system (ORS) insertion as a treatment option for cystic CP.Methods: Between January 2018 and January 2020, 12 patients with enhanced cystic CP were treated by cyst fenestration and aspiration on the day of surgery, and an ORS was inserted. The period between the procedure time and the last outpatient visit was considered the follow-up period. Results:The main presenting symptoms were increased intracranial pressure, visual defects, and hormonal changes. The clinical symptoms improved, and the tumour cysts appeared to stabilize after catheter placement without the need for repeated aspirations; of the 12 patients included, only one case needed re-aspiration. The eight patients who had signs of increased intracranial pressure reported resolved symptoms (100%). Of the 12 patients, seven and six patients showed improved visual acuity and improved visual field defect. Conclusion:Cyst fenestration and insertion of ORS is a safe and effective treatment option for cystic CP. ORS can be used in de novo cases as a treatment option alone without further invasive treatment to alleviate symptoms and improve clinical status, especially the visual changes.