Outcome of postoperative intratumoral bleomycin injection for cystic craniopharyngioma

Total excision is a treatment of choice in preventing the relapse of craniopharyngioma, but for tumors involving an extensive area, it is often associated with an increased risk of complications. We have performed a partial or subtotal tumor removal followed by repeated injection of bleomycin into the remaining tumor through a subcutaneous reservoir as postoperative adjuvant therapy. A retrospective review of clinical, radiological, and surgical data was performed for 10 patients (5 males and 5 females; age, 3-65 yr; follow-up duration, 12-79 months) with cystic craniopharyngiomas. The measurements of lactate dehydrogenase (LDH) level at each aspiration were performed, The shrinkage and/or stabilization of tumor was initially noted in all cases. The recurrence of tumor was seen in 4 cases (40%). The decreased or increased level of LDH was interpreted as tumor shrinkage or recurrence, respectively. The transient toxic reactions were observed in 3 patients (30%). Our study demonstrates that postoperative bleomycin injection for cystic craniopharyngioma, although does not appear to eradicate the tumor, decreases and stabilizes the tumor size, when used as an adjuvant therapy in young patients.