Reoperation for medulloblastoma prior to adjuvant therapy

Prayash Patel, David Wallace, Frederick Boop, Brandy Vaughn, Giles W. Robinson, Amar Gajjar, Paul Klimo

Research output: Contribution to journalArticle

Abstract

Background: Surgery remains an integral part of the treatment of medulloblastoma. We present our experience with repeat surgery for this tumor before initiation of adjuvant therapy. Objective: To report what was found intraoperatively and where at time of second-look surgery and detail any postoperative events or readmissions within 90 days of surgery. Methods: Two separate institutional databases were queried to identify patients who underwent repeat resection of suspected residualmedulloblastoma from January 2003 to January 2017. Results: We identified 51 patients (36 male, 15 female) who underwent repeat surgery. Average age at diagnosis was 8.31 years (range, 1.3-21.2). Imaging prior to repeat surgery demonstrated unequivocal residual tumor in 37 patients, but indeterminate in 14 patients. All but 1 patient had histopathologically confirmed residual tumor (50/51, 98%). The fourth ventricle was the primary site in 39 (76%) cases, compared with hemispheric in 12 cases (24%). Thirty (59%) tumors were non-WNT/non-SHH. All indeterminate cases (except for 1 patient) had residual tumor. Hemostatic agents were found within the resection cavity in 80% of indeterminate cases. The most common sites of residual tumor were lateral (26/39, 67%, lateral recess and/or foramen of Luschka) and roof (25/39, 64%); the superior medullary velumwas the most commonregion of the roof (19/25, 76%). Eight (16%) patients developed new neurological deficits: cranial nerve palsies in 5 patients and posterior fossa syndrome in 3 patients. Conclusion:Meticulous inspection of the resection cavity is necessary, paying particular attention to the roof and lateral recess. Hemostatic agents can conceal residual tumor.

Original languageEnglish (US)
Pages (from-to)1050-1057
Number of pages8
JournalNeurosurgery
Volume84
Issue number5
DOIs
StatePublished - Jan 1 2019

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Medulloblastoma
Reoperation
Residual Neoplasm
Therapeutics
Hemostatics
Second-Look Surgery
Fourth Ventricle
Cranial Nerve Diseases
Ambulatory Surgical Procedures
Neoplasms
Databases

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

Cite this

Patel, P., Wallace, D., Boop, F., Vaughn, B., Robinson, G. W., Gajjar, A., & Klimo, P. (2019). Reoperation for medulloblastoma prior to adjuvant therapy. Neurosurgery, 84(5), 1050-1057. https://doi.org/10.1093/neuros/nyy095

Reoperation for medulloblastoma prior to adjuvant therapy. / Patel, Prayash; Wallace, David; Boop, Frederick; Vaughn, Brandy; Robinson, Giles W.; Gajjar, Amar; Klimo, Paul.

In: Neurosurgery, Vol. 84, No. 5, 01.01.2019, p. 1050-1057.

Research output: Contribution to journalArticle

Patel, P, Wallace, D, Boop, F, Vaughn, B, Robinson, GW, Gajjar, A & Klimo, P 2019, 'Reoperation for medulloblastoma prior to adjuvant therapy', Neurosurgery, vol. 84, no. 5, pp. 1050-1057. https://doi.org/10.1093/neuros/nyy095
Patel P, Wallace D, Boop F, Vaughn B, Robinson GW, Gajjar A et al. Reoperation for medulloblastoma prior to adjuvant therapy. Neurosurgery. 2019 Jan 1;84(5):1050-1057. https://doi.org/10.1093/neuros/nyy095
Patel, Prayash ; Wallace, David ; Boop, Frederick ; Vaughn, Brandy ; Robinson, Giles W. ; Gajjar, Amar ; Klimo, Paul. / Reoperation for medulloblastoma prior to adjuvant therapy. In: Neurosurgery. 2019 ; Vol. 84, No. 5. pp. 1050-1057.
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