Medulloblastoma is a pediatric malignant tumor that already develops in embryonic cells, therefore occurs predominantly in childhood. Medulloblastoma occurence is approximately 20% of all brain tumors in children. Rarely medulloblastoma affects the adult brain. This tumor develops in the cerebellum, in the part of the skull, which is called "the posterior cranial fossa," Medulloplastoma enters a rare group of central nervous system tumors, which can metastasize in spinal cord and ependyma of the ventricles of the brain.
Irradiation and environmental influences may have some connection with the development of brain tumors in children. Family and hereditary diseases cal also be a cause.
5% of patients with autosomal dominant carcinoma develop medulloblastoma.
40-50% of the children who have chromosome 17 are under the risk.
The first signs of any brain tumor are usually associated with increased intracranial pressure, which causes the headache, vomiting (usually in the morning) and vision problems.
The classic triad of symptoms are morning headaches, vomiting and lethargy. Headache gradually decreases during the day. Cushing's triad (hypertension, bradycardia, hypoventilation) is rare for children with increased intracranial pressure and if this triad is found, then, as a rule, it may indicate impending herniation.
Children with medulloplastoma symptoms quickly get tired, complain of fatigue and become irritable quickly. Since the cerebellum part of the brain controls muscle coordination, medulloblastoma can cause walking problems, disbalance of motion and speech disorder. Other specific symptoms connected with medulloblastoma are nystagmus, stiff neck and muscle weakness. children may also experience the gradually worsening ataxia in lower ligaments. Infiltration of the tumor in the brain stem or increased intracranial pressure can lead to diplopia and compression of certain cranial nerves, which can lead to the stigness of facial features, distant ringing in the ears, the hearing loss and stiff neck.
The medulloplastoma symptoms depend on the size and location of the brain tumor.
The main method of diagnosis is magnetic resonance imaging and contrasted computed tomography. MRI study of the spinal cord gives an indication of the presence or absence of metastases.
For a medulloplastoma treatment doctors usually use a combination of surgery, radiotherapy and chemotherapy.
Radical treatment for medulloblastoma is its surgical removal. If the patient's condition allows, it is better to totally remove the cancer. During surgery the doctors use microsurgical techniques, such as intraoperative MRI navigation.
Radiosurgical intervention may be applied in case the surgical intervention is impossible or it may be adjunct to surgery when the radiosurgical effect is directed on the residual portions of the tumor (for example, the surgeon can not remove the whole tumor and then the left cells are irradiated).
If medulloblastoma is completely removed and there no metastases after surgery the radiotherapy is assigned in low doses to minimize the side effects. If metastases or tumor is not completely removed, radiation therapy is used in large doses. Children under three years can not receive the radiotherapy.
Chemotherapy for the treatment of this tumor is part of a comprehensive response and is used after surgical and radiological therapy. The most effective application have the following chemotherapeutic agents: vincristine, procarbazine, and nitrosoureas.
American scientists have recently offered the complex treatment of medulloblastoma. They inject the measles virus into the body of the child and then subject it to the genetic modification. Experiments on mice have confirmed that the modified measles virus kills malignant medulloblastoma cells in just 72 hours. This can be used only for children who have not had measles before.
Regime and diet is another part of the systemic medulloplastoma treatment. children should eat in small portions, but there should be at least 5 meals. It is also not recommended to force the patient to eat. Children are advised to eat more citrus and grapefruit. Sometimes the taste preferences during treatment can vary and even seem strange.
For symptomatic therapy the surgeons use steroid drugs, antiemetics, anticonvulsants, sedatives and painkillers. An integral part of the treatment of medulloblastoma is a rehabilitation therapy. The main objective of every rehabilitation therapy is to return the patients to their normal life in family and society. The rehabilitation program is made individually for each patient and may include sessions with physiotherapists, rehabilitators, therapists, speech therapists and other specialists.
Prognosis depends on the stage of tumor, presence of metastases, the patient's age and the possibility of radical surgery. If the treatments started early, the 10-year survival rate is about 75%.
pain from the secondary metastases
chemotherapy results in anemia, thrombocytopenia and increased risk of bleeding, The immune system becomes so weak that the patients can eaily catch life-threatening bacterias, viral, fungal infections, nephrotoxicity, ototoxicity, hepatotoxicity, neurotoxicity
radioactive intervention results in neurocognitive and endocrine diseases. It may also bring the myocardial ischemia, secondary manifestation of the central nervous system and thyroid malignancies
Today the mortality from medulloplastoma is very high. It is important to reduce the frequency of adverse outcomes by early detection of the disease and frequent examination. Only then the doctors can use the optimal method of surgical treatment of tumors.
Postoperative mortality is 5% with a big chance of medulloplastoma reccurence and five years after the surgery only 20 - 30% of patients with medulloblastoma survive. The survival rate is more than five years for boys is about 24% and for girls it is just 10%. The younger is the sick child, the more malignant are neoplasms and the faster is the pathological process in the brain stem, which is responsible for vital body functions. The worst prognosis are patients with recurrence medulloplastoma after its removal.
Specific methods of preventing medulloblastoma currently do not exist. There is only study of American physicians who reported that taking special vitamin supplements during the first pregnancy reduces significantly the risk of this tumor. The children should also be checked up as often as possible if they have Chromosome 17 in their genes.Hide
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