Medulloblastoma surgery

Surgical intervention alone is not recommended as a single therapeutic modality for the management of medulloblastoma. According to the risk stratification criterion for medulloblastoma patients, surgery must be followed by the appropriate radiotherapy or chemotherapy management. Surgical excision of medulloblastoma may be done either via a posterior fossa craniectomy approach or a suboccipital craniectomy approach. Complications related to surgery may include aseptic meningitis, haematoma formation, and posterior fossa syndrome.^[1]

• Surgical intervention alone is not recommended as a single therapeutic modality for the management of medulloblastoma.^[1]
• Surgical excision of medulloblastoma may be done either via:

• A posterior fossa craniectomy approach
• A suboccipital craniectomy approach

• The two main objectives of medulloblastoma surgical excision are:

• Resection of the primary brain tumor with the least possible postsurgical residual mass
• Relieve any elevated intracranial pressure among patients with obstructive hydrocephalus

• Intraoperative gentle suction of medulloblastoma is preferred over surgical dissection due to the friable nature of the mass.
• A ventriculoperitoneal shunt may be inserted in 50% of the cases following surgery to manage refractory hydrocephalus.
• A criticism of pre-operative ventriculoperitoneal shunts is that they may promote the metastatic spread of medulloblastoma.^[2]
• Surgical complications may include:

• Aseptic meningitis
• Posterior fossa syndrome
• Cervical instability
• Haematoma formation
• GI bleeding due to shunt placement

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