Clinical and procedural implications of ommaya reservoirs implantation in cystic brain metastases followed by radiosurgery treatment

Abstract

Background: The therapy to large or deep cystic brain metastases is a troublesome problem in clinical department. Stereotactic cyst aspiration combined with Gamma Knife radiosurgery can be an effective treatment for cystic brain metastases. However, there is still a possibility that reaccumulation of cystic fluid may lead to poor efficacy or even reoperation.Case presentation: We present a case of a 67-year-old man who diagnosed with brain metastasis of lung cancer. The intracranial lesion represented in imaging appeared to be cystic and located deep in the brain with the patient’s limb dysfunction. The patient did not respond well to chemotherapy and underwent cyst aspiration with ommaya reservoir implantation. Although turbid fluid may lead to postoperative tube blockage, we still implanted an ommaya reservoir. Repeated cystic fluid reaccumulation and exacerbation of symptoms occurred during treatment. Fortunately, the ommaya reservoir is not blocked. We performed repeated aspiration via ommaya reservoir to cope with such a situation and combined with radiotherapy. During the follow-up period of 14 months, the intracranial tumor was effectively and satisfactorily controlled.Conclusions: We highlight that an ommaya reservoir implantation during stereotactic cyst aspiration is necessary to prevent fluid reacclumulation avoiding the need for a second surgical procedure.