Adult cerebellar medulloblastomas: the pathological, radiographic, and clinical disease spectrum

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✓ The records of 34 patients over 16 years of age with cerebellar medulloblastoma were retrospectively reviewed. All patients were treated by surgery, and all surviving patients were given radiation therapy. The imaging characteristics of this rare entity were evaluated with regard to the tumor location in the cerebellum, and the prognostic effects of histological characteristics such as neuronal or glial differentiation and the presence of desmoplasia were investigated. Neither histological parameters nor tumor location (median, paramedian, or lateral cerebellar) affected patient survival. The desmoplastic variant was encountered in 38% of these adult medulloblastomas and occurred in all three cerebellar locations. The degree of surgical resection did not have a major effect on long-term survival; long-term survival was possible even in patients who had received only a biopsy. The extent of initial radiation therapy was positively correlated with recurrence-free survival; full neuraxis irradiation was associated with a 13% incidence of delayed spinal metastases, whereas 75% of patients treated with irradiation of only the posterior fossa and/or the whole brain developed spinal deposits. A similar local recurrence rate (12.5%) was noted in both irradiation groups. Chemotherapy resulted in palliation in some patients with metastatic disease.

Article Information

Address reprint requests to: Edward R. Laws, Jr., M.D., Department of Neurosurgery, George Washington University, 2150 Pennsylvania Avenue NW, Washington, DC 20037.

Address for Dr. Hubbard: Western Neurological Associates, 610 Winter Street SE, Salem, Oregon 97301.

Address for Dr. Wick: Department of Pathology, University of Minnesota, Minneapolis, Minnesota.

© AANS, except where prohibited by US copyright law.

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Figures

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    Survival data related to the location of the medulloblastoma in 34 patients.

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    Survival curves for differentiated and undifferentiated tumors in 32 patients. One patient in each group died in the immediate postoperative period, and both are excluded from this figure.

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    Computerized tomography scan with contrast enhancement showing a lateral hemispheric medulloblastoma.

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    Midline medulloblastoma: computerized tomography scan with contrast enhancement (left), and magnetic resonance images in the axial (center) and sagittal (right) projections.

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    Survival data related to extent of tumor removal in 34 patients.

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    Recurrence-free survival curves related to radiation therapy for patients surviving to complete their initial courses of irradiation.

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