Medulloblastoma in Childhood

Abstract

20 medulloblastomas in children were treated at the Neurosurgical Department of Perugia over the last 6 years. The age ranged between 1.2 and 15 years, with a mean of 8 years. The ratio between males and females was 3/1. Only three tumors were localized within one cerebellar hemisphere. A shunt was performed before the removal of the tumor in 12 cases. Radical resection was completed in 15 cases, whereas a subtotal removal was performed in the cases with involvement of the brain stem. The postoperative mortality rate was 5%. The 3-year survival rate was 40% and the 5-year 25%. The postoperative radiotherapy was given at lower doses than usually reported by other authors: this seems to reduce the neuropsychological and endocrinological sequelae. CCNU or BCNU were given after radiotherapy, but this monochemotherapy seems to be less effective than polychemotherapy with CCNU, vincristine, procarbazine and dexamethasone, used in this series when relapse occurred. Radical resection improved the prognosis. The opportunity of using different protocols for ‘low risk’ and for ‘high risk’ patients is finally discussed.

Neuroendoscopy Sway in the Treatment of Posterior Fossa Tumours associated Hydrocephalus in Children

“…The proximity of these lesions to the brainstem and fourth ventricle explains the common presentation of these patients. Obstructive hydrocephalus is described in about 80% of the cases, it can lead to herniation and death if left untreated [1][2][3][4][5][6][7].…”

“…Approaches include preoperative insertion of a cerebrospinal fluid shunt or external ventricular drainage followed by surgical resection of the tumor [1,2,4,[6][7][8][9]. Others recommend treatment with corticosteroids and direct approach to the posterior fossa pathology, when possible [10][11][12][13][14][15][16][17].…”

“…The proximity of these lesions to the brainstem and fourth ventricle explains the common presentation of these patients. Obstructive hydrocephalus is described in about 80% of the cases, it can lead to herniation and death if left untreated [1][2][3][4][5][6][7].The best way to handle obstructive hydrocephalus secondary to posterior fossa tumor is still subject to debate. Approaches include preoperative insertion of a cerebrospinal fluid shunt or external ventricular drainage followed by surgical resection of the tumor [1,2,4,[6][7][8][9].…”

“…It is currently established popularity emulates the diversity of increasing applications, which are also reflective of integral challenges. Based on recent reports [6,7,13,18,19]. Neuroendoscopic treatment of hydrocephalus (endoscopic third ventriculostomy) is the most recent approach for management.…”