A case report on management of medulloblastoma

Abstract

Medulloblastoma is the most common cancerous brain tumor in children, accounting for nearly 1 in 5 of all pediatric brain tumors. It almost always starts in the lower back part of the brain called the cerebellum, and tends to spread through spinal fluid .Treatment for medulloblastoma usually consists of a combination of surgery, radiation and chemotherapy. About three-fourths of children with medulloblastoma treated with this combined approach survive into adulthood. Survival depends on many factors, including age of diagnosis as well as the size, type, location and growth rate of the tumor. Therapies for medulloblastoma may cause delayed complications that can affect quality of life after treatment.

We report one such rare presentation of medulloblastoma, Mr. 41 years old man with a history of giddiness-June2012 and, He was taking treatment, but for persistence of symptoms he was again adviced MRI brain in Aug 2013 which showed – ill definedhyperintensities in superior cerebellar hemispheres B/L, vermis and middle cerebellar peduncles.MRI spine in Aug 2013 showed degenerative changes in cervical vertebra with indentation of cord in C5 – C6, C6 – C7 levels. CSF analysis was negative for malignant cells. He was furter evaluated – right suboccipital craniotomy and biopsy was done on 2 Nov2013. Biopsy report was in favors of small cell carcinoma. Biopsy material was sent for second opinion to NIMHANS, Bangalore on 27 Nov 2013. Final diagnosis of medduloblastoma.WHO grade IV; cerebellum. He received radiation therapy for 45 days from 16 Dec 2013 to 28 Jan 2014. He was notable to tolerate radiation, then adviced for chemotherapy. At this point the patient was started on immunonutritive therapy in april 2014 by Dr.AppaRao. He improved so well in just 3 months and his later reports of MRI done on 20 Dec 2014 was completely normal.