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The authors report the results of internal irradiation with labeled chromic phosphate (32P) and gold-198 (198Au) colloid in eight cases of cystic craniopharyngiomas. They used a newly developed dosimetric formula, by which the radiation dose at the cyst wall and at any point far from the radioactive source can be calculated. Ten courses of irradiation in eight patients were carried out by injection of either 32P or 198Au colloid into the cyst through an Ommaya drainage system that had been placed at craniotomy. Follow-up studies ranging from 13 to 156 months revealed that all cysts were effectively treated, with elimination of fluid or collapse of the cyst. This was confirmed by Conray cystography and/or computerized tomography. Not only the dose delivered to the wall but also the thickness of the cyst wall and the location of the cyst are important factors in planning internal irradiation. A safe and adequate dose to the cyst wall could range between 9000 to 30,000 rads for craniopharyngioma. This treatment is suitable for large cysts that are thought to be difficult to remove radically, recurrent cysts resistant to previous treatment, or multiple cysts. Internal irradiation may also be applicable in other cystic intracranial tumors if dosimetry is calculated accurately.
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PMID:Internal irradiation for cystic craniopharyngioma. 627 32

Papillary thyroid carcinoma is the most common thyroid malignancy and usually has an indolent clinical course with a good prognosis. Brain metastasis from thyroid cancer is very rare, occurring in only 0.8-1.3% of all papillary thyroid carcinomas; therefore, the prognosis and treatment of the metastatic tumor are unclear. We describe 5 cases of brain metastases from papillary thyroid carcinoma treated with surgery between 2013 and 2017. Intracranial tumor resection was performed and brain metastases were pathologically diagnosed as papillary thyroid carcinoma in 2 men and 3 women aged 62-72 years(mean 67 years). The surgical treatment for the thyroid cancer was total thyroidectomy in 3 patients, hemithyroidectomy in 1, and no treatment in 1. The duration from initial diagnosis to brain metastasis was 0-155 months(mean 73.2 months). Two patients also received radioiodine therapy. Three patients had multiple lesions and 2 had single lesions. Four patients also had other metastases. Neuroimaging demonstrated intratumoral hemorrhages in 2 patients. The other 2 patients had intratumoral hemorrhage during the course of the disease. All patients received radiation therapy after surgery for brain metastases. Two patients died, but the other 3 have survived to date. The other 2 patients who had intratumoral hemorrhage during the course of the disease received <sup>131</sup>I radioiodine therapy. It was reported that <sup>131</sup>I radioiodine therapy resulted in collapse of the fragile peritumoral vessels. It is safe to perform head magnetic resonance imaging(MRI)before radioiodine therapy for thyroid cancer. Papillary thyroid carcinomas carry a good prognosis but some brain metastases have a poor prognosis due to the presence of other metastases or the patient's poor general condition. Treatments for patients in good general condition are needed to improve the clinical course and prognosis.
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PMID:[Treatment of Brain Metastases from Papillary Thyroid Carcinomas:Five Surgical Cases in Our Hospital and a Literature Review]. 3045 34

Purpose: For many patients with intracranial tumors, accurate surgical resection is a mainstay of their treatment paradigm. During surgical resection, image guidance is used to aid in localization and resection. Intraoperative brain shift can invalidate these guidance systems. One cause of intraoperative brain shift is cavity collapse due to tumor resection, which will be referred to as "debulking." We developed an imaging-driven finite element model of debulking to create a comprehensive simulation data set to reflect possible intraoperative changes. The objective was to create a method to account for brain shift due to debulking for applications in image-guided neurosurgery. We hypothesized that accounting for tumor debulking in a deformation atlas data framework would improve brain shift predictions, which would enhance image-based surgical guidance. Approach: This was evaluated in a six-patient intracranial tumor resection intraoperative data set. The brain shift deformation atlas data framework consisted of n = 756 simulated deformations to account for effects due to gravity-induced and hyperosmotic drug-induced brain shift, which reflects previous developments. An additional complement of n = 84 deformations involving simulated tumor growth followed by debulking was created to capture observed intraoperative effects not previously included. Results: In five of six patient cases evaluated, inclusion of debulking mechanics improved brain shift correction by capturing global mass effects resulting from the resected tumor. Conclusions: These findings suggest imaging-driven brain shift models used to create a deformation simulation data framework of observed intraoperative events can be used to assist in more accurate image-guided surgical navigation in the brain.
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PMID:Accounting for intraoperative brain shift ascribable to cavity collapse during intracranial tumor resection. 3261 27