230. Safety Of Ommaya Reservoir Insertion In Children With Craniopharyngioma

Authors: Laura-Nanna Lohkamp; Abhaya Kulkarni; James Drake; James Thomas Rutka; Peter Benjamin Dirks; Michael Taylor; George Monir Ibrahim; Brian William Hanak; Maria Lamberti-Pasculli; Lorena Baroni; Eric Bouffet; Ute Katharina Bartels (Toronto, Canada)

Introduction:

Craniopharyngiomas (CP) are the most common non-glial CNS tumors in children. Although they are considered benign (WHO grade I), the morbidity of surgery and radiation often results in severe long-term consequences. Ommaya reservoir implantation (ORI) into cystic CP represents a minimally invasive intervention that may delay endocrine, hypothalamic and visual deterioration. The purpose of this study was to assess the overall morbidity of ORI in pediatric CP.

Methods:

A retrospective chart review of children with CP treated with ORI at the Hospital for Sick Children was performed from 01/01/2000 to 1/07/2019.

Results:

Of 79 children diagnosed with CP at the Hospital for Sick Children, 41 underwent ORI with a median follow-up of 6.1 years (range 0.02-17.2 years). The median age at diagnosis was 7.8 years (range 0.8-18.0 years). A total of 75 surgeries, comprised of 62 new catheter insertions and 13 revisions were performed. ORI was performed as upfront treatment in 36 patients. The most common reason for reinsertion was the diagnosis of a new cystic CP component (n=15), for delayed revision surgery the presence of catheter dysfunction (n=6), respectively. 5 patients (12%) required one or more immediate revisions due to malpositioning of the catheter (n=3) or infection (n=2). There were no permanent neurological deficits following ORI although transient visual deficits occurred in 4 children. There were no clinical variables associated with the need for revision surgery.

Conclusion:

ORI is a safe procedure in pediatric CP patients with a low overall morbidity. Catheter revisions are common due to blockage and often multiple catheters are required to address complex, multi-cystic lesions. Further studies are required to characterize the benefit of ORI with respect to delay of neuroendocrine deficits, definitive surgery and radiation.