Recurrent Cystic Formation in Craniopharyngioma Treated with Radioactive Chromic Phosphate

Abstract

The problem of treating recurrent, cystic craniopharyngioma is at times an extremely trying one. When each craniotomy results in improvement of visual fields, but then when timre is rapidly recurring general symptomatology and once more loss of sight occurs, both the patient and the surgeon begin to wonder if the short span of improvement is worth the hardships incident to another craniotomy. Drawing on the experience gained by others in treating neoplastic effusions of various body cavities with radioactive chromic phosphate, we decided to use this material to treat a case of recurrent cystic craniopharyngioma which had become a complete enigma to us in regard to further therapy. This has, we feel, resulted in a solution of the problem as illustrated in the following case report.Case Report 1st Admission. TCT, No. 50479M, an 18-year-old Latin-American barber from Odem, Texas, was first seen at the University of Texas Medical Branch Hospital on Jan. 6, 1958. He had never noted any visual deficit until 1 month previously when he began to complain of failing eyesight which became increasingly worse to the point where he felt he was blind in his left eye. He could still see out of his right eye, but he required help in walking in order to avoid running into objects. For ~ or 8 weeks he had had dull headaches which at times were associated with nausea and vomiting and which were relieved by aspirin. These had become much more severe in the 8 days prior to admission.The only significant finding in his past history was that he had been treated in a tuberculosis sanatorimn for 4 years and during that period had had a thoracotomy.When examined, he was somewhat apathetic and sluggish in his responses. With the left eye he could perceive only light and movement of hands, but in the right eye, ~0/100 vision was preserved. Visual fields revealed a temporal-field deficit on the right; the left could not be tested.Roentgenograms of the skull showed enlargement and erosion of the sella with decalcification of the clinoid processes. There was no pathologic calcification. Pneumoencephalography indicated a filling defect of the anterior part of the 3rd ventricle and the chiasmatic cistern, while arteriography confirmed the fact that a suprasellar mass was present.

Interstitial Irradiation of Skull Base Tumours

“…This technique was pioneered in the early 1950's and applied stereotactically by Leksell and Liden (1952). 35 The initial agent used was phosphorus-32 [36][37] but other isotopes have been introduced ( Table 1). The ideal isotope for intracystic therapy would have a half-life of several days, beta energy low enough to ensure minimal tissue penetration, and no or minimal gamma emission.…”

Treatment ofCraniopharyngiomas: The Multimodality Approach

“…Leksell could never forget this, and the project was resumed. Meanwhile, the idea had been tried by others [2][3][4][5][6][7][8], obviously with limited success.…”