Clinical features and surgical approaches of medulloblastoma

doi:10.3877/cma.j.issn.2095-123X.2021.01.011

Abstract

Abstract:

Objective

To investigate the clinical characteristics and the selection of surgical approach for medulloblastoma (MDB) in children.

Methods

Retrospective analysis of clinical data of 32 children with MDB who were treated by cerebellar medullar fissure (CMF) approach (including 28 cases of unilateral cerebellar medullar fissure approach and 4 cases of bilateral CMF approach) from January 2011 to December 2019 in Neurosurgery Department of Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital. The clinical features and prognosis of the patients were analyzed.

Results

Among 32 cases, 28 patients (87.5%) were <10 years old, 21.9% were <3 years old and 65.6% were male. The longest duration of the disease in all patients was 6 months, and 71.9% cases were within 3 months, the main symptoms were intracranial hypertension and ataxia. Most of the MDBs were located in vermis or midline (90.6%), only 9.4% in cerebellum hemisphere, and 9.4% of MDB oppressed brain stem. The total resection rate was 90.6% in 29 patients, 3 patients were subtotal resection, 1 patient was complicated with cerebellar mutism, full recovery was achieved after 1 month. There were no surgical related deaths and no permanent cerebrospinal fluid leakage.

Conclusion

CMF approach is the optimal surgical approach for MDB, which is in line with minimally invasive surgery principles. Mastering the clinical features of MDB and the principles and skills of CMF approach, combined with the exquisite minimally invasive neurosurgery techniques, contributes to improving the curative effect of MDB.

Key words: Medulloblastoma, Cerebellar medullar fissure approach, Children

Lihua Chen, Kai Sun, Wenjin Chen, Yong Xia, Hongtian Zhang, Ruxiang Xu. Clinical features and surgical approaches of medulloblastoma[J]. Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition), 2021, 11(01): 41-47.

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References 15

[1]	Bailey P, Cushing H. Medulloblastoma cerebelli: a common type of midcerebellar glioma of childhood[J]. Arch Neurol Psychiatry, 1925, 14(2): 192-224.
[2]	Matsushima T, Abe H, Kawashima M, et al. Exposure of the wide interior of the fourth ventricle without splitting the vermis: Importance of cutting procedures for the tela choroidea[J]. Neurosurg Rev, 2012, 35(4): 563-571; discussion 571-562.
[3]	Ellison DW, Kocak M, Dalton J, et al. Definition of disease-risk stratification groups in childhood medulloblastoma using combined clinical, pathologic, and molecular variables[J]. J Clin Oncol, 2011, 29(11): 1400-1407.
[4]	Halperin EC, Friedman HS. Is there a correlation between duration of presenting symptoms and stage of medulloblastoma at the time of diagnosis?[J]. Cancer, 1996, 78(4): 874-880.
[5]	Quinlan A, Rizzolo D. Understanding medulloblastoma[J]. JAAPA, 2017, 30(10): 30-36.
[6]	Wilne S, Collier J, Kennedy C, et al. Progression from first symptom to diagnosis in childhood brain tumours[J]. Eur J Pediatr, 2012, 171(1): 87-93.
[7]	Ramaswamy V, Remke M, Shih D, et al. Duration of the pre-diagnostic interval in medulloblastoma is subgroup dependent[J]. Pediatr Blood Cancer, 2014, 61(7): 1190-1194.
[8]	Jittapiromsak P, Sabuncuoglu H, Deshmukh P, et al. Accessing the recesses of the fourth ventricle: comparison of tonsillar retraction and resection in the telovelar approach[J]. Neurosurgery, 2010, 66(3 Suppl Operative): 30-40.
[9]	Han S, Wang Z, Wang Y, et al. Transcerebellomedullary fissure approach to lesions of the fourth ventricle: less is more?[J]. Acta Neurochir (Wien), 2013, 155: 1011-1016.
[10]	Piatt JH, Kellogg JX. A hazard of combining the infratentorial supracerebellar and the cerebellomedullary fissure approaches: cerebellar venous insufficiency[J]. Pediatr Neurosurg, 2000, 33(5): 243-248.
[11]	陈立华，徐如祥，魏群,等.小脑延髓裂入路在第四脑室和脑干背侧肿瘤手术中的临床应用[J].临床神经外科杂志, 2017, 14(5): 360-365.
[12]	Tanriover N, Ulm AJ, Rhoton AL Jr, et al. Comparison of the transvermian and telovelar approaches to the fourth ventricle[J]. J Neurosurg, 2004, 101(3): 484-498.
[13]	Deshmukh VR, Figueiredo EG, Deshmukh P, et al. Quantification and comparison of telovelar and transvermian approaches to the fourth ventricle[J]. Neurosurgery, 2006, 58(4 Suppl 2): ONS-202-206; discussion ONS-206-207.
[14]	Kumabe T, Fujimura M, Jokura H, et al. Surgical treatment for choroid plexus tumors in the fourth ventricle: brain stem infiltration hinders total extirpation[J]. Neurosurgical Review, 2008, 31: 165-172; discussion 172.
[15]	El-Bahy K. Telovelar approach to the fourth ventricle: operative findings and results in 16 cases[J]. Acta Neurochirurgica, 2005, 147(2): 137-142.

项目		数据[例（%）]
年龄
	<3岁	7（21.9）
	3~10岁	21（65.6）
	>10岁	4（12.5）
性别
	男	21（65.6）
	女	11（34.4）
病程
	<3个月	23（71.9）
	3~6个月	9（28.1）
症状
	颅内高压	21（65.6）
	共济运动障碍	12（37.5）
	颅神经	6（18.8）
	长束症状	2（6.3）
肿瘤大小
	<4 cm	17（53.1）
	4~6 cm	13（40.6）
	>6 cm	2（6.3）
肿瘤位置
	中线	20（62.5）
	蚓部	9（28.1）
	半球	3（9.4）
肿瘤侵袭
	第四脑室底侵袭	7（21.9）
	脑干侵袭	3（9.4）
	小脑脚受累	11（34.4）

项目		数据[例（%）]
年龄
	<3岁	7（21.9）
	3~10岁	21（65.6）
	>10岁	4（12.5）
性别
	男	21（65.6）
	女	11（34.4）
病程
	<3个月	23（71.9）
	3~6个月	9（28.1）
症状
	颅内高压	21（65.6）
	共济运动障碍	12（37.5）
	颅神经	6（18.8）
	长束症状	2（6.3）
肿瘤大小
	<4 cm	17（53.1）
	4~6 cm	13（40.6）
	>6 cm	2（6.3）
肿瘤位置
	中线	20（62.5）
	蚓部	9（28.1）
	半球	3（9.4）
肿瘤侵袭
	第四脑室底侵袭	7（21.9）
	脑干侵袭	3（9.4）
	小脑脚受累	11（34.4）

项目		例数	全切除	次全切除
肿瘤分期
	M0	25（78.1）	24（75.0）	1（3.1）
	M1~4	7（21.9）	5（15.6）	2（6.3）
危险度分级
	低危组	9（28.1）	9（28.1）	0
	中危组	12（37.5）	12（37.5）	0
	高危组	11（34.4）	8（25.0）	3（9.4）

项目		例数	全切除	次全切除
肿瘤分期
	M0	25（78.1）	24（75.0）	1（3.1）
	M1~4	7（21.9）	5（15.6）	2（6.3）
危险度分级
	低危组	9（28.1）	9（28.1）	0
	中危组	12（37.5）	12（37.5）	0
	高危组	11（34.4）	8（25.0）	3（9.4）

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