The focused radiation produced by radiosurgery offers the theoretical advantage of a reduced radiation dose to surrounding structures during the treatment of residual
craniopharyngiomas when compared with fractionated
radiotherapy. A retrospective analysis of 23 patients treated since 1992 was undertaken. Intracystic
bleomycin treatment in 10 patients with cystic
tumors proved to be effective in preparing the
tumors for radiosurgery. The mean prescription dose in this series was 10.8 ¿ 8.7 Gy delivered to a mean prescription 47% isodose. There was a volume reduction of the
residual tumor in 74%. In this series, initial
tumor volume and target volume were significant prognostic factors. Smaller
tumors and targets were more likely to shrink. Five patients with large multicystic residual or recurrent
tumors after multiple surgical attempts showed further progression. The maximum radiation dose, prescription dose and choice of prescription isodose were not significant prognostic factors within this series. Radiosurgery resulted in no mortality and no significant morbidity could be attributed to it. Clinically, the best results with radiosurgery were obtained with monocystic
tumors amenable to stereotactic drainage and intracystic
bleomycin treatment.