Fatal toxic effect of bleomycin on brain tissue after intracystic chemotherapy for a craniopharyngioma: Case report

OBJECTIVE AND IMPORTANCE: Craniopharyngiomas are benign neoplasms of epithe lial origin that arise from the remnants of Rathke's pouch and are located in the sellar, parasellar, and third ventricular regions. Despite major adv ances in microsurgical techniques, total removal of these tumors is associa ted with a high risk of death, long-term endocrinological dependence, cogni tive dysfunction, and behavioral disorders. For patients with monocystic cr aniopharyngiomas, encouraging postoperative survival rates and high rates o f cyst regression after intracavitary administration of bleomycin have been reported. Moreover, only a few side effects have been reported for this tr eatment method, We report a patient with a cystic craniopharyngioma who was treated using intracavitary bleomycin administration and died as a result of the direct toxic effects of bleomycin on deep brain structures and the b rainstem, CLINICAL PRESENTATION AND INTERVENTION: A 47-year-old woman with a cystic c raniopharyngioma underwent stereotactic insertion of a catheter attached to a subcutaneous reservoir. Five months after the procedure, positive-contra st computed tomographic cystography was performed to confirm the absence of fluid leakage. Daily intracavitary injections of bleomycin were administer ed through the reservoir into the cyst, until a total dose of 56 mg had bee n administered in 8 days, After the treatment, the cystic cavity regressed but the patient exhibited neurological deterioration; magnetic resonance im aging scans revealed diffuse edema in the diencephalon and brainstem. The p atient died 45 days after completion of the treatment. CONCLUSION: Intracavitary administration of bleomycin is not a treatment pr otocol without risks or side effects, even if there is no fluid leakage int o the cerebrospinal fluid. Although this is known to be an effective treatm ent for cystic craniopharyngiomas, previous reports cannot be used to estab lish a standard treatment method, and more research is needed to yield a sa fer effective protocol.