Vascular abnormalities in pediatric craniopharyngioma patients treated with radiation therapy

Craniopharyngioma is a benign brain tumor that can be treated with some combination of surgery, intracystic chemotherapy and radiation therapy. Treatment for craniopharyngioma, especially radiation therapy, is associated with a variety of long-term toxicities including vascular abnormalities. We report on the incidence of vascular abnormalities seen in the children with craniopharyngioma who received radiation therapy at our institution.

We reviewed our experience with craniopharyngioma patients who received radiation therapy from 1995 to 2008. We reviewed clinical data including surgery, chemotherapy, radiation therapy and imaging for vasculopathy.

Twenty of the 22 children with craniopharyngioma who received radiation therapy had imaging available. Six of the 20 were found to have some type of vasculopathy. One had bilateral temporal cavernomas, one had moyamoya syndrome, one had an aneurysm of the internal carotid artery and three children had decreases in the caliber of the carotid or cerebral arteries, but were asymptomatic. Two of the six children with abnormalities also received intracystic bleomycin prior to radiation therapy.

We report a high incidence of vascular abnormalities in children with craniopharyngioma. The data suggest that intracystic bleomycin may contribute to radiation-related vasculopathy. We now include magnetic resonance angiography as part of our routine follow up in these children.