Spinal Metastasis in Primitive Neuroectodermal Tumors (Medulloblastoma) of the Posterior Fossa: Evaluation with CT Myelography and Correlation with Patient Age and Tumor Differentiation

George, Richard E.; Laurent, John P.; McCluggage, Charles W.; Cheek, William R.

doi:10.1159/000120239

Cited by 17 publications

(16 citation statements)

References 10 publications

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“…However, in the present study patients were only screened for spinal metastases if they had obvious clinical symptoms. This implies that only large metastases were identified, and indeed our study shows an exceedingly low incidence of spinal metastases when compared with other investigators [10,15]. Alternatively, it is possible that a certain proportion of spinal metastases present at the time of diagnosis might have been cured by standard radiotherapy of the neuraxis.…”

Section: Incidence Of Spinal Seedingsupporting

confidence: 55%

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Secondary manifestation of medulloblastoma: Metastases and local recurrences in 66 patients

et al. 1995

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Although primary treatment of medulloblastoma is now successful in a high percentage of patients, its secondary manifestations still bear a poor prognosis. Thorough studies of secondary manifestations are therefore pivotal to plan therapeutic approaches for the long-term management of medulloblastoma. Here we describe the incidence of secondary tumour manifestations in 66 patients of a single centre who underwent surgery for medulloblastoma between 1975 and 1990. No patient was excluded due to a poor postoperative course. Thirty-five patients showed evidence of secondary tumour growth. Of these, 17 suffered from local recurrence, and 27 developed metastastatic disease. The median latencies for secondary manifestations were 25 months for local recurrence (n = 17), 11 months for spinal metastases (n = 10), 15 months for supratentorial metastases (n = 8), 8 months for subleptomeningeal dissemination (n = 6), and 23 months for systemic metastases (n = 8). Two patients developed primary metastatic spread to the posterior fossa. Of 8 patients with supratentorial metastases, 6 developed fronto-basal lesions. In our patients, 89% of secondary lesions occurred within less than 3 years after primary diagnosis. 85% of patients with extra-axial tumour spread had been treated with a permanent shunt. Radical tumour resection and radiotherapy with 30 Gy to the neuraxis and 20 Gy boost to the posterior fossa was an important prognostic factor in this series. Patients with additional chemotherapy did not benefit significantly from this treatment. We conclude that optimal management of the primary lesions should aim at (i) total resection, (ii) avoid permanent shunting, and (iii) completion of the radiotherapy with inclusion of the medial frontobasal cisterns in the radiotherapeutic regimen. Our analysis suggests that adequate postoperative screening programmes should consist of 3-monthly scans of the neuraxis in the first three postoperative years and 6-monthly scans thereafter.

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Section: Incidence Of Spinal Seedingsupporting

confidence: 55%

“…However, secondary tumour growth still bears a poor prognosis [22,35,46,47] and treatment is not standardized. Secondary manifestations at time of diagnosis or as recurrence show a broad variety of different locations and disease-free intervals [5,11,15,34,42].…”

Section: Introductionmentioning

confidence: 99%

Secondary manifestation of medulloblastoma: Metastases and local recurrences in 66 patients

et al. 1995

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“…Particular care should be used when obtained either myelographic or MR staging of potential spinal metastases postoperatively as blood clots and debris may stimulate intradural lesions during the first 14 days postoperatively [1,14,15]. A very high number of patients (42%) imaged during the early postoperative period have 'positive' CTmyelography [16]. When myelography is delayed to 30 days after resection of the medulloblastoma, approximately 10% (confirmed with CSF cytology) a b show have a positive myelogram [17].…”

Section: Spinal Stagingmentioning

confidence: 99%

Neuroradiology of pediatric posterior fossa medulloblastoma

Blasér

Harwood-Nash

1996

J Neuro-Oncol

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Medulloblastoma of the cerebellum is a common intracranial neoplasm in children and presents many faces in medical imaging. Characteristic or classic features, such as increased attenuation on unenhanced CT, midline location and well defined margins, are commonly present in childhood cases of posterior foassa medulloblastoma, although atypical imaging features are being noted more frequently with the increased dependence on MR as the diagnostic modality of choice. Carefully performed CT and MR both initially provide suitable geography and characteristics, but MR is superior in the detection of pre- or post-operative neoplastic spread elsewhere in the subarachnoid space. Accurate establishment of disease extent is essential in planning both surgical resection and adjuvant therapy.

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“…They further emphasized the high rate of metastatic disease in children under five. More recent authors reported high incidence (42-44%) asymptomatic spinal metastases, particularly younger patients group [5,6].…”

Section: Discussionmentioning

confidence: 94%

“…Studies by postoperative staging myelography have shown a various rates (11--44%) of asymptomatic spinal metastases [2][3][4][5][6]. The literature has also demonstrated that cytology for neoplastic cells in the cerebrospinal fluid (CSF) has been often associated with positive myelography for metastatic disease [2,3].…”

Section: Introductionmentioning

confidence: 99%

Medulloblastomas in childhood: Postsurgical evaluation with myelography and cerebrospinal fluid cytology

et al. 1990

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Thirty-one children with medulloblastoma treated at the Children's Memorial Hospital have been evaluated with both postoperative myelography and cerebrospinal fluid (CSF) cytological studies. Computed tomography of the spine following myelography was used in an attempt to increase sensitivity. Each study was done 30 days after radical resection of the posterior fossa tumor, and just prior to the spinal irradiation. Only 3 (9.6%) showed positive results for spinal subarachnoid seeding by both myelography and CSF cytology. In 2 of these patients, preoperative head CT showed evidence of intracranial subarachnoid seedings. The incidence of positive myelographic finding in our series is lower than reported ones, and neoplastic cells are detected in the CSF only when the myelography shows visible disease.

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Spinal Metastasis in Primitive Neuroectodermal Tumors (Medulloblastoma) of the Posterior Fossa: Evaluation with CT Myelography and Correlation with Patient Age and Tumor Differentiation

Cited by 17 publications

References 10 publications

Secondary manifestation of medulloblastoma: Metastases and local recurrences in 66 patients

Secondary manifestation of medulloblastoma: Metastases and local recurrences in 66 patients

Neuroradiology of pediatric posterior fossa medulloblastoma

Medulloblastomas in childhood: Postsurgical evaluation with myelography and cerebrospinal fluid cytology

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