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The effect of reoperation in case of residual tumor
after surgery needs to be studied.
4. W
hat
is
the
incidence
of
hydrocephalus
in medulloblastoma
?
Due to the fact that different types of tumor, presenting
medial or lateral location, produce different incidences
of hydrocephalus and different outcomes in terms of re-
lief of cerebrospinal fluid flow blockage after tumor re-
section, we only used studies that exclusively addressed
medulloblastomas or allowed evaluating the data sepa-
rately for each type of tumor.
Data extraction
Kombogiorgas,
21
Hoffman
22
and Muzundar
23
studied
specific series of medulloblastoma. Muzundar, in a se-
ries of 154 patients (2001-2010), found hydrocephalus
in 96.5% of cases. Komborgiorgas, in 2008, found 100%
of hydrocephalus in 20 patients, while Hoffman, in a
series of 44 patients, observed hydrocephalus in 93.18%
of patients. The three studies yielded an average of
96.56% of hydrocephalus in patients with medulloblas-
toma.
(C)
5. W
hat
is
the
effect
of
tumor
resection
for
the
resolution
of
hydrocephalus
?
•
•
Due-Tønnessen and Helseth
24
needed cerebrospinal
fluid shunt in 53% of resected medulloblastomas.
(C)
•
•
Kombogiorgas,
21
in 2008, operated 20 patients with
medulloblastoma with 4 requiring shunt (20%).
(C)
•
•
Gopalakrishnan el al.
25
showed that 36.8% of 38 pa-
tients with medulloblastoma required CSF shunt.
(C)
•
•
Kumar et al.
26
showed that 22.72% of their patients
needed post-operative shunt. Seven out of the 55 pa-
tients undergoing total resection required CSF shunt
(12.7%), compared with 13 of the 33 treated with par-
tial resection (39.3%).
(C)
•
•
Moreelli
27
had 6 out of 27 patients operated for me-
dulloblastoma (22.22%) requiring CSF shunt.
(C)
•
•
Lee et al.
28
studied 42 patients and found a need for
CSF shunt in 17 (40%).
(C)
The average need for CSF shunt after tumor resection was
32.45% (20 to 53%). Tumor resection treats the associat-
ed hydrocephalus in 67.55% of cases.
(C)
Recommendation
Tumor removal is recommended for the treatment of hy-
drocephalus.
(C)
6. W
hat
is
the
effect
of
endoscopic
third
ventriculostomy
in
hydrocephalus
associa
-
ted
with
medulloblastoma
compared
with
ventriculoperitoneal
shunt
?
The electronic search is described in Annex I. 64 studies
were retrieved, but only one by El-Ghandour
29
(B)
compared
endoscopic third ventriculostomy (ETV) and ventriculo-
peritoneal shunt (VPS) in the treatment of pediatric pa-
tients with severe obstructive hydrocephalus due to tumors
in the posterior fossa in 53 cases (32 medulloblastomas).
Data extraction
In the third-ventriculostomy group, complications oc-
curred in three patients (two intraoperative bleeding, and
one case of cerebrospinal fluid leaks), while the CSF shunt
group, complications occurred in six patients (shunt in-
fection in two cases, with one death; subdural collection
in two cases; epidural hematoma in one case; and upward
herniation in one case). Endoscopic third ventriculosto-
my required less surgical time compared with ventricu-
loperitoneal shunt (15 min
vs
. 35 min).
Data from a single non-randomized study with no
major differences in complications between the groups
(6
vs
. 3) do not allow us to assert the superiority of one
method or another.
Recommendation
Third-ventriculostomy and ventriculoperitoneal shunt
are options in the treatment of hydrocephalus persisting
after surgical removal of medulloblastoma.
7. T
he
use
of
radiotherapy
is
needed
in me
-
dulloblastoma
?
A study by Bouffet
30
(C)
, performed in 1992, postponed
radiation only in the supratentorial area and kept RxT in
the posterior fossa and spinal cord. Patients had relapsed
medulloblastoma in the supratentorial area. Based on
this study, radiation therapy has been performed in me-
dulloblastoma to prevent recurrence.
33-35
Recommendation
Supra- and infratentorial radiotherapy is recommended
to treat children with medulloblastoma (aged 3 years or
younger).
(B)
8. S
hould
radiotherapy
be
given
to
chil
-
dren
under
3
years
?
Lafay-Cousin et al.
31
(B)
studied 29 patients with medul-
loblastoma aged three years or younger, comparing the