Delayed cerebrovascular complications of intrathecal colloidal gold.
OBJECTIVE
Therapy with intrathecal colloidal gold has been used in the past as an adjunct in the treatment of childhood neoplasms, including medulloblastoma and leukemia. We describe the long-term follow-up period of a series of patients treated with intrathecal colloidal gold and emphasize the high incidence of delayed cerebrovascular complications and their management.


METHODS
Between 1967 and 1970, 14 children with posterior fossa medulloblastoma underwent treatment at the University of Minnesota. Treatment consisted of surgical resection, external beam radiotherapy, and intrathecal colloidal gold. All patients underwent long-term follow-up periods.


RESULTS
Of the 14 original patients, 6 died within 2 years of treatment; all experienced persistent or recurrent disease. The eight surviving patients developed significant neurovascular complications 5 to 20 years after treatment. Three patients died as a result of aneurysmal subarachnoid hemorrhage, and five developed ischemic symptoms from severe vasculopathy that resembled moyamoya disease.


CONCLUSIONS
Although therapy with colloidal gold resulted in long-term survival in a number of cases of childhood medulloblastoma, our experience suggests that the severe cerebrovascular side effects fail to justify its use. The unique complications associated with colloidal gold therapy, as well as the management of these complications, are presented. We recommend routine screening of any long-term survivors to exclude the presence of an intracranial aneurysm and to document the possibility of moyamoya syndrome.
Nussbaum
E S
ES
Department of Neurological Surgery, University of Minnesota Hospital and Clinic, Minneapolis, Minnesota 55455, USA. nussb002@tc.umn.edu
Sebring
L A
LA
Neglia
J P
JP
Chu
R
R
Mattsen
N D
ND
Erickson
D L
DL
D000293:Adolescent; D000328:Adult; D017542:Aneurysm, Ruptured / Q000139:chemically induced / Q000473:pathology; D002423:Cause of Death; D002528:Cerebellar Neoplasms / Q000188:drug therapy* / Q000473:pathology; D002536:Cerebral Arteries / Q000187:drug effects / Q000473:pathology; D002561:Cerebrovascular Disorders / Q000139:chemically induced* / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D017979:Gold Colloid / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D007278:Injections, Spinal; D002532:Intracranial Aneurysm / Q000139:chemically induced / Q000473:pathology; D008297:Male; D008527:Medulloblastoma / Q000188:drug therapy* / Q000473:pathology; D009072:Moyamoya Disease / Q000139:chemically induced / Q000473:pathology; D013345:Subarachnoid Hemorrhage / Q000139:chemically induced / Q000473:pathology
D017979:Gold Colloid