A Novel Low Recurrence Surgical Approach for Medulloblastoma Excision: A Study of 58 Cases

To describe a novel surgical approach to decrease the complication and recurrence rates of medulloblastomas.

A retrospective review was performed. The novel technique was performed under similar conditions for all patients. The technique involved early intra-operative identification of the superior part of the floor of the fourth ventricle, so that the inferior part of the tumor could be viewed directly and excised thoroughly. Importance was given to the pattern of tumor growth and CSF flow dynamics.

A total of 58 patients underwent this surgery between February-2006 and May-2016. Mean age was 13.2 years (Range ? 6 months to 55 years). Follow-up ranged from 1 to 11 years. 49 patients (84.4%) who were under the age of 3 years were administered craniospinal radiation as well as chemotherapy. 9 patients (15.6%) over the age of 3 years were administered only chemotherapy. Total excision could be performed in 50 cases (86.2%) and subtotal excision ( > 90% excision) in 8 cases (13.8%). The tumor recurred in only 1 patient (1.72%). The complications included akinetic mutism (8.6%), meningitis (8.6%), 6th & 7th nerve paresis/palsy (5.17%), and chest infection (3.44%). Death occurred in 2 patients (3.44%), causes of death were unrelated to surgery.

This study highlights the possible benefits of this novel approach to medulloblastoma excision by decreasing recurrence and complication rates and increasing rates of total excision. However, studies with large cohorts need to be performed to evaluate its efficacy.