Background: Craniopharyngiomas are common pediatric tumors. Adherence to nearby critical structures often precludes complete excision. Bleomycin chemotherapy via Ommaya reservoir has been shown to shrink the cystic tumor and decrease recurrence. However, complications related to leakage when administered in the vicinity of important structures have been reported. To the best of our knowledge and search, this is the second report of myelitis due to bleomycin toxicity affecting the spinal cord, far from the primary tumor site. A child with recurrent adamantinomatous craniopharyngioma underwent tumor decompression with placement of an Ommaya reservoir into the cyst cavity. After confirming the system's watertight integrity, the patient received 14 doses of intracystic bleomycin. One month after treatment, he developed progressive weakness in both lower limbs followed by upper limbs, hypesthesia below C3 level, and urinary retention. MR imaging revealed extensive T2 hyperintensity and contrast enhancement extending from C2 to the conus. A comprehensive evaluation for infectious, inflammatory, and autoimmune causes was conducted, but no identifiable etiology was found. Bleomycin-induced diffuse myelitis was suspected, and the patient improved with high-dose steroids. Repeat MRI at 4 months after treatment showed partial regression of myelitis correlating with clinical improvement.
Conclusion: Despite positive outcomes, intratumoral bleomycin carries a ~10% risk of local complications. Severe neurotoxicity, like myelitis, can occur without obvious peritumor CSF leakage, requiring careful monitoring during treatment. Further research is needed to develop safer, standardized protocols.
Keywords: Bleomycin-induced myelitis; Craniopharyngioma; Neurotoxicity.
© 2025. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.