Experiences with radioactive gold in the treatment of craniopharyngioma

The treatment of choice for craniopharyngioma is still controversial and probably ought to vary in individual cases. Where the histological structure is benign a total removal has seemed an ideal to aim at. The lesion is, however, frequently adherent to the hypothalamus, to main cerebral vessels, and to the optic tracts as well as to the pituitary stalk, and attempts at total removal have resulted in a for-bidding operative mortality even when the attempt was abandoned because the operation proved technically impossible. When apparently complete removal was achieved there was still a substantial recurrence rate (35 %) in the survivors (Gordy, Peet, and Kahn, 1949). In many instances histological examination showed anaplastic cell growth and mitotic figures, malignant changes which precluded any serious attempt at surgical extirpation. The lesion usually consists of one or more cysts, though about one in 10 is a solid tumour. After incomplete removal of a cyst wall and aspiration of contents in most of the surviving patients the lesion recurred in three to six months (Ingraham and Scott, 1946), although an occasional patient survived longer, even up to 13 years. Russell and Pennybacker (1961) pointed out that the course was more variable in older patients, and that there might be spontaneous remissions lasting as long as 20 years, though 10 out of 24 patients were dead within 15 months of first being seen. The cause of deterioration was probably an increase in volume of cyst contents, though there was little to show how this came about. Oedema on a vascular basis was proposed to explain the fluctua-tions in the clinical state arising from solid tumours. In the younger patients at least simple aspiration, decompression, and ventriculo-cisternostomy (Tor-kildsen's operation) afford usually only temporary relief. Although craniopharyngioma has frequently been regarded as radio-resistant, several workers have reported a useful result from radiotherapy on a small number of cases (Love and Marshall, 1950) with periods of survival up to eight years. Ingraham and Scott (1946) advocated irradiation instead of decompression for a later recurrence. Carpenter,