gms | German Medical Science

Objective: Medulloblastoma is the most common malignant brain tumor in children, whereas it represents less than 5 % of all brain tumours in adults. We have focused on our clinical data, treatment and outcome for medul-loblastoma in adults in order to find out whether these differ from those in children.

Methods: During the last 25 years 12 adult patients (6 female, 6 male) with medulloblastoma (mean age: 30.2 years, range: 18 to 49 years) were treat-ed. Clinical, radiological and histological findings were analysed. Treatment modalities and outcome were compared with data from the literature.

Results: The duration of clinical symptoms such as headache (12), vertigo (7) and ataxia (4 patients) ranged from two weeks to one and a half years prior to diagnosis. On the CT scan followed by MRI, an enhancing mass was found either within the fourth ventricle with invasion of one cerebellar hemisphere (7), or in the midline (5) with obstructive hydrocephalus (7 patients). In one case initial spinal metastasis was seen. All patients un-derwent tumour resection (complete: 9) via a suboccipital craniotomy. Histological examination revealed desmoplastic medulloblastoma (4) and medulloblastoma (8). Surgery was followed by irradiation (complete neuroaxis and boost of the tumor bed, 11) and/or chemotherapy (e.g. HIT`91-protocol, 8). The follow-up period ranged from 5 to 24 years (5 year survival: 92%). One patient died due to brain stem dysfunction a few days after surgery. Recurrence was seen in only one patient, 4 years after the first treatment.

Conclusions: Adult patients with medulloblastoma, especially with des-moplastic medulloblastoma, have a favourable prognosis, similar to or ex-ceeding that of children. Desmoplastic morphology and tumour location appear to be important factors, as well as radical surgery and aggressive adjuvant therapy (irradiation and chemotherapy).