Medulloblastomas are generally well-defined midline cerebellar lesions with regions of mineralization, intratumoral cysts and blood vessels and heterogeneous enhancement. Because of the propensity for medulloblastomas to disseminate, the entire neuroaxis must be imaged. In addition, the CSF should be analyzed for the presence of tumor cells as the tumor tends to spread along the CSF pathways.

Treatment. Dorsal exophytic brainstem tumors and cervicomedullary tumors are amenable to surgical resection, followed by chemotherapy or radiation for progressive or symptomatic tumors that cannot be completely removed. Tectal gliomas are generally managed by addressing the hydrocephalus, although larger or progressive tumors may need further treatment. Diffuse infiltrating pontine lesions are treated with a combination of fractionated radiotherapy and chemotherapy.

Initial treatment of medulloblastomas consists of surgical resection, with the extent of surgical resection a significant prognostic factor. Subsequent treatment depends on whether patients fall into “average risk” (older than 3 years, with near or total resection of the tumor and no evidence of disseminated disease) or “high risk” (younger than 3 years, less than near-total resection and evidence of disseminated disease) categories. Average-risk patients are treated with lower doses of radiation and less chemotherapy.

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