| ORIGINAL ARTICLE |
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| Year : 2006 | Volume
: 1
| Issue : 1 | Page : 16-20 |
Medulloblastoma in children: Prognostic factors and predictors of outcome
Girish Menon, S Nair, T Muthurethinam, K Krishnakumar, RN Bhattacharya
Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences &Technology, Trivandrum, India
Correspondence Address:
Girish Menon
Department of Neurosurgery, SCTIMST, Trivandrum 695 011
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/1817-1745.22942
Objective: To determine the relative contributions of clinical, radiological and histopatholgical predictors of survival in children with medulloblastoma (MB) and to compare it with their adult counterparts. Materials and Methods: Retrospective case record analyses of 79 children (<16 y) operated after Jan. 1990, who have completed at least 5 y of follow-up. The following variables were assessed by bivariate analysis: age, CT scan location of the lesion, brainstem invasion, extent of excision, histological subtype. Statistical analysis was performed using Chi-square test, Fischers test and Student's t test. Results: Near-total to total excision could be achieved in 59 (74.6%) cases. Twenty-three patients (29.11%) required CSF diversion procedures. Histopathology revealed features of classical medulloblastoma in 63.2%, thermoplastic variant in 11% and glial differentiation in 25.3% of cases. Postoperative mutism was seen in 14 (17.72%) patients. All patients received adjuvant therapy. On follow-up, 34 patients were found to have posterior fossa recurrence and four patients were re-operated. An additional 17% of patients were found to have either spinal or supratentorial metastasis on follow-up. The overall 5-year recurrence-free survival rate was 19 (24.05%). Mortality was recorded in 23 patients and nearly 29 patients who were severely disabled on follow-up were referred to terminal care centres. Conclusion: In spite of recent advances in management, children with medulloblastoma still carry a poor prognosis. We observed poor outcome in children below 7 y of age. Vermian location had a better outcome in adults but not in children. Desmoplastic variant was observed to be a significant prognostic factor in paediatric, group while brain stem invasion carried poor prognosis for both.
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