Medulloblastoma with brain stem involvement: The impact of gross total resection on outcome

Amar Gajjar, Robert A. Sanford, Ravi Bhargava, Richard Heideman, Andrew Walter, Yulan Li, James W. Langston, Jesse J. Jenkins, Michael Muhlbauer, James Boyett, Larry E. Kun

Research output: Contribution to journalArticle

39 Scopus citations

Abstract

We studied the impact of gross total resection on progression-free survival (PFS) and postoperative morbidity in 40 children with locally advanced meduUoblastoma characterized by tumor invading the brain stem. These patients represented 40% of children treated for newly diagnosed meduUoblastoma at a pediatric oncology center over a 10-year period. All patients underwent aggressive initial surgical resection. Review of surgical and neuro-imaging findings documented gross total resection in 13 cases, near-total resection (< 1.5 cm2 residual tumor on imaging) in 14 cases, and subtotal resection (> 50% resection with > 1.5 cm2 residual) in 13 cases. Overall, 85% of patients had a >90% resection. Subsequent therapy comprised craniospinal irradiation in all cases and chemotherapy on institutional or cooperative group protocols in 35 cases. At a median follow-up of 4 years, postirradiation PFS is 61% (SE = 10%). There was no difference in PFS for patients who underwent gross total resection compared to those with any detectable residual tumor (p > 0.70). The posterior fossa syndrome occurred in 25% of cases, and had no apparent relationship to the extent of resection (p > 0.5, exact test). In this series, true gross total resection was not associated with a PFS advantage when compared to strictly defined near-total and subtotal resection. Although there was no operative mortality, the frequency of the posterior fossa syndrome is of concern and emphasizes the need for careful consideration of the risk/benefit ratio in the surgical approach to this subgroup of patients.

Original languageEnglish (US)
Pages (from-to)182-187
Number of pages6
JournalPediatric Neurosurgery
Volume25
Issue number4
DOIs
StatePublished - Jan 1 1996

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Keywords

  • Brain stem invasion
  • Extent of resection
  • MeduUoblastoma
  • Pediatric tumors

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Surgery
  • Clinical Neurology

Cite this

Gajjar, A., Sanford, R. A., Bhargava, R., Heideman, R., Walter, A., Li, Y., Langston, J. W., Jenkins, J. J., Muhlbauer, M., Boyett, J., & Kun, L. E. (1996). Medulloblastoma with brain stem involvement: The impact of gross total resection on outcome. Pediatric Neurosurgery, 25(4), 182-187. https://doi.org/10.1159/000121121