The patient was operated by me 14-November-2006 for huge craniopharyngioma through bifrontal approach and Ommaya reservoir was inserted to the bed of the residual tumor. The patient then came 23-May-2015, telling that she got polyuria and double vision and epigastric pain for 4 months and ataxia for 2 months with tremor four limbs. CT-scan done 20-November-2014 was unremarkable without evidence of hydrocephalus. MRI of the brain done 19-April-2015 showing huge cystic mass in the III ventricle compressing the mesencephalo-pontine structures.

On examination; the patient has difficult walking and cannot stand for Romberg evaluation. There is left sided paresis 3/5. The deep reflexes exaggerated in the left side

The patient was sent for investigations and the MRI of the brain done 23-May-2015 showing the huge cystic mass. Prolactine was 33 ng/mL. Minrin nasal spray decreased the polyuria.

Using Inomed Planning software, RM stereotactic instrumentation and intraoperative MRI, the huge cystic mass of the craniopharyngioma was reached without violating the arterio-venous structures and even the CSF compartments. Ommaya ventricular tube was inserted 100.12 mm length. The fluid content was evacuated slowly to avoid bleeding from the surrounding structures. 2 ml Omnipaque was injected inside the cystic mass and using the C-arm, the cavity was washed until the cavity was completely empty. The Ommaya reservoir was connected and the skin was closed. MRI was done before awakening the patient. The cystic mass completely suffered shrinkage and there is no bleeding.

Smooth postoperative recovery. The power of the left upper limb improved and the power of the left lower limb showed more improvement. The patient was sent to the ICU for 24 hours observation.

The patient was operated 9 years ago for huge craniopharyngioma and Ommaya reservoir inserted to the bed of the tumor. The recurrence came from different angle.