Background: Although medulloblastoma commonly affects children, 15% to 36% of cases are reported to occur in adults. Objective: To determine the outcome of a management policy for adult medulloblastoma and to evaluate the impact of proposed prognostic factors on outcome. Methods: The study included 15 adult patients (mean age of 25.5±9.3 years) with newly diagnosed biopsy-confirmed medulloblastoma confined to the craniospinal axis with a duration of symptoms of 6.1±3 weeks. All underwent brain MRI (CT scan for 5) and spinal evaluations; surgical resection followed by external-beam radiotherapy to the entire craniospinal axis and 7 had chemotherapy. Regular clinical and radiological follow-ups were designed. Results: Patients with hydrocephalus (n=12) underwent ventricular shunt procedures prior to surgery. Total resection was feasible in 8, subtotal in 4; partial in 2; infeasible (biopsy only) in 1 patient. Radiotherapy was initiated 40±20 days after surgery. The follow-up duration ranged from 6 to 72 months. Five patients had recurrence after 18±12.5 months; 3 in the surgical beds and 2 as bone metastasis. Three patients with recurrence died with a 3-year relapse-free of 66.7%; 3-year morbidity secondary to recurrence 13.3%; and a 3-year mortality rate of 20%. There was a negative correlation between possibility of relapse and extent of surgical resection and was found as a specific predictor for relapse-free postoperative course. Conclusion: The assumed policy of surgical resection, when possible, followed by radiotherapy and chemotherapy was an appropriate therapeutic modality for adult medulloblastoma. The extent of surgical resection was a predictor of prognosis after such treatment policy. (Egypt J Neurol Psychiat Neurosurg. 2010; 47(2): 289-296)
Key Words: Adult, Medulloblastoma, Posterior fossa, Primitive neuroectodermal tumor.
Correspondence to Alaa El-Azazi, Department of Neurosurgery, Cairo University. Tel: +20101417185. Email: alaaazzazi@yahoo.com