ABSTRACT

Background: Medulloblastoma is one of the most common malignancy of the brain in

children, mainly located in the posterior fossa of the cerebellum, presenting at mean age of 9
years and found more in men. Metastatic disease commonly presented at diagnosis (40%)
Treatment modalities vary from chemotherapy, radiotherapy and surgical intervention. Risk
of recurrence and death is higher in metastatic medulloblastoma. However, the optimal
treatment for children with metastatic medulloblastoma is unknown.
Objectives: To describe the management choices the author took for pediatric spine and lung
metastatic medulloblastoma.
Method: we present a case of 8-year-old boy with obstructive hydropcephalus,
medulloblastoma in the posterior fossa, IDEM with spine and lung metastasis. Patient first
presented with weakness of lower extremities, headache and vomiting. Spinal MRI was done
and patient then reffered to tertiary center for further management. We performed VP shunt
and suboccipital craniectomy tumor removal. We plan to conduct chemotherapy and
radiotherapy regiments on the patient post-op.
Results: Surgical resection depends on anatomy of t. Patient with hydrocephalus may need
CSF diversion and shunt placement. In patients with metastases, risk stratification is
important to decide on the adjuvant therapies following surgical intervention. High risk
patients undergo radiotherapy (54-55.8Gy) with high dose CSI (36.0 Gy) followed by
adjuvant chemotherapy. Various regiments for chemotherapy is available but standard therapy
is post-radiation cisplatin-based for 4 to 9 cycles.
Conclusion: Current knowledge of medulloblastoma treatments in children has been well-
studied however, the optimisation of multimodal therapy especially in metastasied
medulloblastoma in unclear. In terms of managing metastatic medulloblastoma in children,
future research are needed in order to treat medulloblastoma in children for curative efforts
and improving quality of life.
Keywords: medulloblastoma, metastatis, management, multimodalities
Disclosure conflict of interest: the author declares no conflict of interest