Delayed cerebrovascular complications of intrathecal colloidal gold

OBJECTIVE: Therapy with intrathecal colloidal gold has been used in the pas t as an adjunct in the treatment of childhood neoplasms, including medullob lastoma and leukemia. We describe the long-term follow-up period of a serie s of patients treated with intrathecal colloidal gold and emphasize the hig h incidence of delayed cerebrovascular complications and their management. METHODS: Between 1967 and 1970,14 children with posterior fossa medulloblas toma underwent treatment at the University of Minnesota. Treatment consiste d of surgical resection, external beam radiotherapy, and intrathecal colloi dal gold. All patients underwent long-term follow-up periods. RESULTS: Of the 14 original patients, 6 died within 2 years of treatment; a ll experienced persistent or recurrent disease. The eight surviving patient s developed significant neurovascular complications 5 to 20 years after tre atment. Three patients died as a result of aneurysmal subarachnoid hemorrha ge, and five developed ischemic symptoms from severe vasculopathy that rese mbled moyamoya disease. CONCLUSION: Although therapy with colloidal gold resulted in long-term surv ival in a number of cases of childhood medulloblastoma, our experience sugg ests 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 intracr anial aneurysm and to document the possibility of moyamoya syndrome.