Medulloblastoma is the most common primary malignant central nervous system tumor arising in childhood. Survival rates for children with medulloblastomas have nearly doubled and so has the recognition that many survivors are impaired and new forms of treatment are needed. Its understanding and management represents both the progress and challenges involved in the treatment of children with brain tumors over the past quarter century. Medulloblastomas arise in the fourth ventricle, between the brain stem and cerebellum in a region termed the posterior-fossa. Symptoms may be caused by direct compression of the tumor of structures in this region of brain or due to blockage of cerebrospinal fluid at the outlets of the third or fourth ventricles and secondary hydrocephalus. Common symptoms include headaches and vomiting due to hydrocephalus and progressive unsteadiness. Diagnosis is usually made within one to three months of onset of symptoms, as medulloblastoma is a fast growing tumor. Occasionally due to bleeding within the tumor, a patient will be in a coma or have severe acute neurologic compromise at the time of diagnosis.
Roger J. Packer, MD
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