Intracystic Bleomycin Injection for Craniopharyngioma: Case Report

Hwang, Sung Nam; Kim, Young Baeg; Park, Seung Won; Choi, Duk Young

Abstract

As craniopharyngioma is histologically benign, recent trend of managing this tumor has been complete surgical removal without adding any adjuvant therapy. But because of its close relation with surrounding vital structures, total removal sometimes results in unacceptable neurologic sequelae. To avoid these serious complications various management options have been suggested. Among these, bleomycin injections into the cystic cavity have been sporadically reported with satisfactory results. The authors report a 50-year-old woman presented with visual symptoms, who was found to have a largely cystic craniopharyngioma. Because the boarder between the tumor and hypothalamus was ill defined, intracystic bleomycin injection followed by delayed surgery was scheduled. A total of 80mg bleomycin was given over the 8 days. After the treatment high fever, skin rash and mental change developed but these symptoms were gradually subsided and the cysts were shrunken with surrounding infarction. During the follow-up period, visual symptoms became rapidly worse for which surgery was undertaken. Optic nerve was severely compressed by the underlying solid tumor and overlying A1 portion of the anterior cerebral artery. The tumor was near totally removed without any vascular insult. After the operation, the patient remained drowsy and lapsed into coma 6 days later and died. CT scan just before her death showed an infarct in the right ACA and MCA territories suggesting ICA occlusion. The cause of ICA occlusion remained to be unsolved.