Outcome of medulloblastoma with neuraxial dissemination: An analysis of nine cases

Abstract

Nine cases of treated medulloblastomas, who developed single or multiple supratentorial and other neuraxial disseminations at follow-up, were studied retrospectively regarding their course, route of spread, and outcome. These cases were encountered over a period of 9 years out of all treated pediatric medulloblastomas (posterior fossa) between 1999 and July 2005. The records of all the cases were maintained on a computer database under ICD-9 classification in the hospital records department. All nine cases developed frontal or subfrontal metastases, while two developed small recurrences in the posterior fossa. Two of nine cases developed multiple spread within the neuraxis. Surgical excision of frontal metastases was performed in two cases and chemotherapy was offered in seven cases. The following inferences were drawn from this analysis. (i) Supratentorial or any neuraxial dissemination may occur as early as 6 months or may be delayed for up to 9.5 years. (ii) Dissemination of disease may not be associated with recurrence at the primary site in most of the cases. (iii) Even chemotherapy may not be promising in all the cases, but it may prolong survival in some cases, if it is tolerated well. (iv) Surgical excision of metastasis may have risk of further dissemination of disease.