Follow up of Medulloblastoma’s Treatment Retrospective Study of 144 Cases

Abstract

Introduction: Medulloblastoma is the most common childhood primary CNS tumor, and treatment approaches have evolved over the past three decades. Despite recent improvements in cure rates, prediction of disease outcome remains a major challenge and survivors suffer from serious therapy-related side-effects. Patients and Methods: A retrospective study including 144 patients with medulloblastoma were performed at the Neurosurgery Department in Ait IDDIR Health Hospital Establishment between The period of January 2004 and December 2014. In each case, diagnosis was made clinically and confirmed radiologically and histo-pathologically. All patients were operated and received the adjuvant treatment Results and discussion: Out of 144 patients, 63 (44%) patients were females and 81 (56%) were males. We have 59 cases who had age ranged from 05 months to 5 years, however, we had 85 cases who had more than 5 years; we identified 29 (58%) children and 21 (42%) adults. Clinical manifestations of meduloblastoma vary widely according to the location. The vermis is the main location of the child with 95%. The most frequent clinical manifestations found were Intracranial hypertension syndrome and static and kinetic cerebellar syndrome, 98% patients had intracranial hypertension at diagnosis: 1,4% with engagement (2 cases) and 0,7% with coma(01 case). A ventriculo-peritoneal shunt was performed in all patients, 01 case after surgical removal. The most common complications were as follows: Meningitis ( 0,2%),ventriculitis (0,2%), CSF leakage (0,4%), post-surgical hematoma (0,2%), Shunt dysfunction ( 0,6%), aggravation of the cerebellar syndrom (0,4%), affection of mixed nerves ( 0,2%) and cerebellar mutism (0,4%). Tumor architecture was classified as classic (Grade II) and desmoplasic. We had T2M0 in 41(28,47%) cases, T2M2 in 2 (1,38%)cases ,T3aM0 in 98(68%)cases,T3bM3 in 2(1,38%) cases and T3bM4 in 1 (0,7%)case. During follow-up period, recurrence occurred in 15 (10%) cases, sustentorial metastasis in 04 (2,7%) cases, leptomeningeal dissemination in 03 (2%) cases and medullary metastasis in 03 (2%) cases. The five years survival rate was 84%. Conclusion: the surgical treatment of medulloblastoma remains a difficult therapeutic challenge because they have the most virulent form of the disease and are at highest risk for treatment-related sequelae.