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Medulloblastoma in Children

What is pediatric medulloblastoma?

Medulloblastoma is a fast-growing brain cancer that can spread through the cerebrospinal fluid to the brain and spinal cord. It is the most common malignant brain tumor in children, accounting for about 20% of all pediatric brain tumors. Medulloblastoma occurs in the cerebellum, the part of the brain that controls balance, coordination, and other complex motor functions. Specifically, the tumor is in the posterior fossa, the lower rear part of the brain. Medulloblastoma is also known as a cerebellar primitive neuroectodermal tumor (PNET). About 350 cases are diagnosed in the U.S. each year, and more than 70% of patients are under the age of 10. While it may feel like an overwhelming diagnosis, medulloblastoma typically responds well to treatment.

Causes of a medulloblastoma

Medulloblastoma tumors occur when cells develop poorly early in a child’s life. Although the exact cause is unknown, researchers have identified genetic changes that may play a role in the development and growth of this type of tumor. Medulloblastoma is associated with certain inherited conditions, including Li-Fraumeni syndrome, Gorlin syndrome, and Turcot syndrome.

Signs of a pediatric medulloblastoma

Some children may not have symptoms, but the pressure on the brain may cause drowsiness, headaches, and nausea. A child may have coordination problems, difficulty with muscle control, and changes in appetite. Other symptoms may include hearing and vision problems. A patient may tilt their head to one side. If the tumor has spread to the spinal cord, a child might experience back pain, trouble walking, and problems controlling bladder and bowel functions.

Diagnosis

When a brain tumor is suspected after a physical and neurological exam, the doctor usually schedules an MRI or a CT scan of the brain. If a tumor is discovered in the posterior fossa of the brain, an MRI of the brain and spine will be ordered to determine the anatomical features of the tumor and assess whether it has spread. The next step will be surgical resection of the tumor. The tumor will be tested after surgery to confirm the diagnosis.

Treatment

Surgery to remove as much of the tumor as possible is the first line of treatment for medulloblastoma. Traditional surgical treatment requires a craniotomy, during which the neurosurgeon will remove a portion of the skull to access the tumor. The neurosurgeon will use the patient’s own bone to close the opening. If the tumor is completely removed, reduced-dose radiation will likely be administered. If some of the tumor remains, a higher-dose chemotherapy will be ordered. When possible, proton therapy may be used to target the tumor while avoiding healthy tissue.

In some cases, the neurosurgeon can place a ventriculoperitoneal shunt to control increased intracranial pressure. The shunt is a plastic tube that moves the fluid creating pressure inside the brain to the abdomen, where the body absorbs it. With treatment, most children with average-risk medulloblastoma are cancer free five years after diagnosis.

In addition, a clinical trial, called “Combination Intraventricular Chemotherapy Pilot Study: Methotrexate and Etoposide Infusions into the Fourth Ventricle or Resection Cavity in Children with Recurrent Posterior Fossa Brain Tumors,” is open to patients who are age 1 to 21 years old with recurrent medulloblastoma (PNET), recurrent ependymoma, and recurrent atypical teratoid/rhabdoid tumors involving the brain and/or spine. The study infuses two chemotherapy agents directly into the fourth ventricle rather than systemic intravenous delivery. This study is listed at ClinicalTrials.gov, NCT # 02905110, under “Brain Tumor Recurrent.” If you would like additional information about this study, please contact Marcia Kerr, R.N. at marcia.l.kerr@uth.tmc.edu or by calling (713) 500-7363.

What You Can Expect at UTHealth Neurosciences

Our dedicated team uses advanced technology to accurately diagnose and treat neurological diseases and conditions impacting babies and children. We work in multidisciplinary teams of specialists and pediatric neurosurgeons who share insights, leading to better treatment decision-making and outcomes, as well as lower costs and time savings. Throughout treatment, we will work closely with the doctor who referred your family to ensure a smooth transition back to your child’s regular care. While your family is with us, they will receive expert care, excellent communication, and genuine compassion.


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At UTHealth Neurosciences, we offer patients access to specialized neurological care at clinics across the greater Houston area. To ask us a question, schedule an appointment, or learn more about us, please call (713) 486-8000, or click below to send us a message. In the event of an emergency, call 911 or go to the nearest Emergency Room.


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