Ommaya reservoir in complex treatment of patients with brain metastases: Indications, efficacy, prospects

Background. Surgical tactics in treatment of patients with brain metastases and significant cystic component are ambiguous due to the complexity of resection of such tumors in compliance with the principles of thorough oncological treatment. Aim. Presentation of a method for treatment of patients with metastatic lesions in the brain with a large cystic component using minimally invasive neurosurgical intervention: implantation of a chronic subcutaneous drainage system – the Ommaya reservoir. Materials and methods. At the National Medical Research Center of Oncology named after N. N. Blokhin of the Ministry of Health of the Russian Federation, from 2007 to 2022, Ommaya reservoir implantation was performed in 100 patients with various forms of tumors of the central nervous system and significant cystic component. Results and discussion. The use of the technique of implantation of a constant subcutaneous drainage system – the Ommaya reservoir – in complex treatment of patients with brain metastases in most cases allowed to control the size of the cystic component of the tumor with subsequent local radiation exposure. Direct neurosurgical intervention in the form of tumor resection usually does not comply with the principle of thorough oncological treatment of neoplasms with a significant cystic component due to fragmentation of pathological tissue that leads to rapid local recurrence and dissemination. Conclusion. Surgical treatment of patients with brain metastases is a difficult problem due to the need for a combination of adequate neurosurgical and oncological approaches and tactics. Functional accessibility (neurosurgery) and thoroughness (oncology) cannot always be achieved together to an adequate extent. The use of the Ommaya reservoir in complex treatment of patients with brain metastases with a large cystic component has shown its effectiveness and should be used in the routine practice of a neurosurgeon.