Scintigraphic study of cerebrospinal fluid shunts.

This paper deals with experience gained in the study of patency of different types of shunt. Results of subsequent surgery are considered. Findings of 79 scintigraphic studies with radiotechnetium on 68 patients are presented. The method is simple, quick, easy to reproduce and means only moderate radiation load for the patient. Results obtained suggest that this study is a reliable diagnostic tool which can be used in a routine way.

Determination of nasal liquorrhoea by means of radionuclide cisternography.

Ninety-two radionuclide cisternographies were performed on 88 patients with suspected nasal liquorrhoea. To identify fistulae of both traumatic and non-traumatic aetiology, 40 MBq of 169Yb-EDTA was injected to a total volume of 2 ml into the subarachnoid space usually by the cisternal route, but in some cases lumbar routes were chosen. Sixty-seven positive findings were verified by surgery, whereas no surgery was performed in 8 positive cases due to spontaneous clinical healing of the rhinorrhoea. Seventeen patients were studied who did not exhibit actual clinical signs of liquorrhoea. In each case a normal cisternogram was obtained. These cases were not operated upon. Results suggest that this investigation is a simple and reliable diagnostic tool that causes only negligible discomfort to the patient.

Further experiences in the treatment of cystic craniopharyngeomas with yttrium 90 silicate colloid.

20 patients suffering from cystic craniopharyngioma were treated with intracavitary irradiation on 25 occasions. The beta emitting radionuclide 90Y silicate colloid was instilled into the cyst or cystic part of the tumour. 17 patients on 22 occasions underwent follow-up CT and ophthalmological examinations 1 to 144 (average: 34) months after the intracavitary radioisotope therapy. An 23 occasions there was an average of 82 to 90% volume decrease of the craniopharyngioma cysts. On two occasions the volume has remained unchanged and the result of the 90Y therapy cannot be evaluated yet. The neuroophthalmological prognosis was good only when a relatively intact optic disc was seen; when the disc was atrophic the visual deterioration proved to be irreversible. Pathologically, it is the fibrotic tissue that is responsible for the shrinkage of the cyst.

Myeloscintigraphic diagnostics of intramedullary space occupying processes.

This paper concerns the importance of myeloscintigraphy. A study method is presented and the advantages of using 169 Yb-EDTA are discussed. Myeloscintigraphy seems to be a sensitive and reliable diagnostic tool as is shown by the correlation of study results with surgical findings of 23 patients with intramedullary tumors.

The radiotherapy of cystic craniopharyngioma with intracystic installation of 90Y silicate colloid.

The authors describe the intracavital treatment with 90Y silicate colloid in 9 cases of cystic craniopharyngioma. The method has been applied since 1975 in the National Institute of Neurosurgery, Budapest. The intracavital treatment was only one among several applied treatment forms. In all patients a partial removal of the tumour has also been performed. The possibilities of evaluation of the effectiveness of the internal cyst irradiation are therefore limited. In most cases the intracavital treatment resulted in shrinkage of the cyst, or even was followed by its practical disappearence and the condition of the patients shows a decisive improvement. The growth of solid tumour parts is not influenced by this kind of treatment. Therefore the clinical improvement of the patient's condition depends also on the ratio between cyst and solid tumour volume. The optic nerve impairment did not improve in all cases. As a side-effect an oculomotor nerve paresis developed in several patients. Its possible explanations have been discussed, including lasting damage from tumour pressure.