Surgical management of medulloblastoma

Recent technological aids and understanding of pathophysiology has made the surgery of medulloblastoma safer. The guiding principle for the neurosurgeon remains removal of bulky disease, but there is no justification for removal of small amounts of tumor from critical locations. Post-operative complications include hydrocephalus, hematoma, mutism, asceptic meningitis, gastroinstestinal hemorrhage, and cervical instability. Staging is best done preoperatively with MRI, and presence of dissemination remains the most important prognostic factor in this disease. Postoperative surveillance imaging is of questionable value.