Artikel
Intracavitary irradiation of cystic craniopharyngioma by stereotactic instillation of beta-emitting radioisotope (yttrium 90)
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Veröffentlicht: | 20. Mai 2009 |
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Gliederung
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Objective: Despite the existence of many treatment modalities, successful treatment of craniopharyngioma remains challenging. The radical surgical removal of cystic craniopharyngioma is often hazardous due to the vicinity of critical structures and to the inherent tendency of this pathology to recur. The use of intracystic stereotactic instillation of yttrium in our department is revisited.
Methods: Eleven patients harbouring a cystic craniopharyngioma and treated in our department by intracavitary irradiation with yttrium 90 were reviewed. The choice of the radioisotope, the volumetry determination, some technical aspects, and the patients’ evolution are scrutinized. The goal of the treatment was the delivery of a cumulative dose of 200Gy at the inner surface of the cyst wall.
Results: Among the 11 patients were 6 males and 5 females. Their mean age was 30.6 years (range 6–65). Six patients were treated with intracavitary irradiation by the time of diagnosis and required no other treatment up to now. In the 5 other cases yttrium instillation was used in conjunction with other treatment modalities (microsurgery, endoscopy, radiotherapy). After yttrium instillation the mean tumour-free evolution time was 18.6 months (range 6–36), and the mean survival was 7.4 years (range 3 m–24 y). Cyst shrinkage of more than 80% (up to disappearance) occurred in 4 cases. In 5 other cases the cyst was reduced by about 50%. In 2 cases it remained “unchanged”. Vision improved in 8 patients, and did not improve in 2 cases. One patient developed a visual field defect (hemianopia) six months after the treatment. There were no complications occurring during the procedure or in the perioperative period. One patient died three months after the procedure from an unrelated reason.
Conclusions: Intracavitary stereotactic instillation of Yttrium 90 – although ”old fashioned” – still represents a safe, versatile, long-acting and effective method in the armamentarium of the neurosurgeon against cystic craniopharyngioma. It constitutes a minimally invasive method renewable if necessary.