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Peer-reviewedCC BY-NC-ND 4.0Journal of Neurosurgery: Case Lessons

Management of a progressive post–Gamma Knife thalamic cyst using an Ommaya reservoir: illustrative case

  • Antonia Gragg1
  • Marco Failla Mulone2
  • Dominic A. Siler2
  • Ahmed M. Raslan1
  1. 1Neurosurgery Department, Oregon Health and Science University, Portland, Oregon
  2. 2Department of Neurological Surgery, University of Wisconsin, Madison, Wisconsin
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Abstract

BACKGROUND: Delayed cyst formation is a known complication of Gamma Knife (GK) stereotactic radiosurgery (SRS). Estimates of this phenomenon occurring after GK-SRS for arteriovenous malformation are 1.6%–3.6%. Management strategies include aspiration, craniotomy, and shunt placement. This case report describes the placement of an Ommaya reservoir for recurrent symptomatic thalamic cyst formation after GK thalamotomy for essential tremor.

OBSERVATIONS: A 74-year-old female underwent left ventral intermediate nucleus GK thalamotomy for a medically refractory essential tremor in 2013 using a single 135-Gy shot. Eight years later, she developed right-sided motor symptoms and slurred speech. MRI demonstrated a left thalamic cyst with mass effect on adjacent thalamic structures and the posterior limb of the internal capsule. Initial burr hole biopsy and aspiration led to complete symptom resolution, but the cyst recurred. Her symptoms progressed and she underwent placement of a left Ommaya reservoir. She did well for approximately 1 year and then presented to the clinic with similar symptoms and worsened head tremor. CT showed a 2.8 × 2.1 × 1.5–cm cyst. Cyst aspiration via the Ommaya reservoir provided improvement in speech, gait, and head tremor.

LESSONS: Ommaya reservoir placement may provide a minimally invasive and repeatable treatment option for recurrent symptomatic thalamic cysts after GK-SRS, particularly when intermittent decompression is preferred over permanent shunt placement or open surgical intervention.

https://thejns.org/doi/10.3171/CASE26595

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Cite

BibTeXRIS
BibTeX
@article{gragg2026management,
  title = {{Management of a progressive post–Gamma Knife thalamic cyst using an Ommaya reservoir: illustrative case}},
  author = {Antonia Gragg and Marco Failla Mulone and Dominic A. Siler and Ahmed M. Raslan},
  journal = {Journal of Neurosurgery: Case Lessons},
  year = {2026},
  month = oct,
  doi = {10.3171/case26595},
  url = {https://doi.org/10.3171/case26595},
  note = {CC BY-NC-ND 4.0},
}
RIS
TY  - JOUR
TI  - Management of a progressive post–Gamma Knife thalamic cyst using an Ommaya reservoir: illustrative case
AU  - Antonia Gragg
AU  - Marco Failla Mulone
AU  - Dominic A. Siler
AU  - Ahmed M. Raslan
PY  - 2026
DA  - 2026/10/26
JO  - Journal of Neurosurgery: Case Lessons
DO  - 10.3171/case26595
UR  - https://doi.org/10.3171/case26595
AB  - BACKGROUND: Delayed cyst formation is a known complication of Gamma Knife (GK) stereotactic radiosurgery (SRS). Estimates of this phenomenon occurring after GK-SRS for arteriovenous malformation are 1.6%–3.6%. Management strategies include aspiration, craniotomy, and shunt placement. This case report describes the placement of an Ommaya reservoir for recurrent symptomatic thalamic cyst formation after GK thalamotomy for essential tremor.  OBSERVATIONS: A 74-year-old female underwent left ventral intermediate nucleus GK thalamotomy for a medically refractory essential tremor in 2013 using a single 135-Gy shot. Eight years later, she developed right-sided motor symptoms and slurred speech. MRI demonstrated a left thalamic cyst with mass effect on adjacent thalamic structures and the posterior limb of the internal capsule. Initial burr hole biopsy and aspiration led to complete symptom resolution, but the cyst recurred. Her symptoms progressed and she underwent placement of a left Ommaya reservoir. She did well for approximately 1 year and then presented to the clinic with similar symptoms and worsened head tremor. CT showed a 2.8 × 2.1 × 1.5–cm cyst. Cyst aspiration via the Ommaya reservoir provided improvement in speech, gait, and head tremor.  LESSONS: Ommaya reservoir placement may provide a minimally invasive and repeatable treatment option for recurrent symptomatic thalamic cysts after GK-SRS, particularly when intermittent decompression is preferred over permanent shunt placement or open surgical intervention.  https://thejns.org/doi/10.3171/CASE26595
SN  - 2694-1902
ER  -