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Medulloblastoma Follow-up

  • Author: George I Jallo, MD; Chief Editor: Amy Kao, MD  more...
Updated: Oct 16, 2014

Further Outpatient Care

See the list below:

  • Imaging is the primary mode of monitoring residual disease, efficacy of continuing medical treatment, and recurrence or metastasis. Because medulloblastoma is aggressive, frequent monitoring is essential. MRI should be repeated every 3 months the first year; every 4 months the second year; every 6 months the following 3 years; and yearly thereafter.
  • Radiation therapy is an outpatient procedure.
  • Any signs of change in mental status are indications for outpatient visits, as they may herald hydrocephalus and possible recurrence.
  • Lower cranial nerve or cerebellar signs also may signal recurrence.
  • Taper steroids and monitor adverse effects.

Further Inpatient Care

See the list below:

  • Admit patients in whom further surgical intervention is being contemplated.
  • Chemotherapy usually is administered on an inpatient basis.

Inpatient & Outpatient Medications

See the list below:

  • Taper steroid use. However, chemotherapy and radiation therapy may exacerbate edema and necessitate low-dose corticosteroids for a short period of time.
  • Antiepileptic medication usually is not necessary when the tumor is located in the posterior fossa.
  • Spread of disease to the supratentorial compartment may cause seizures and indicate antiseizure medication.


Transfer may be necessary for treatment at a center familiar with pediatric neurosurgery, pediatric oncology, or pediatric radiotherapy.



No known precautions currently exist to prevent the disease or its recurrence.



See the list below:

  • Hydrocephalus (the most common complication of medulloblastoma) can cause secondary visual problems. Cerebellar dysfunction (the second most common complication of the disease) may lead to problems with coordination and gait. Cranial nerve palsy from brainstem involvement can lead to difficulties with vision, speech, and swallowing. With subarachnoid spread to the spinal cord, the unfortunate complications are radiculopathy and weakness.
  • Complications accompany the treatment of medulloblastoma. Fortunately, most of these complications are transient. The most common complication after surgery is a temporary worsening of ataxia accompanied by nystagmus. One of the most commonly cited complications is cerebellar mutism. The anatomic site of origin is thought to be the deep cerebellar nuclei. The constellation of symptoms includes apathy, minimal-to-absent speech, emotional lability, and refusal to initiate movement. Hemiparesis can accompany mutism. Lower cranial nerves are intact, but the syndrome is accompanied by a swallowing apraxia. It becomes apparent several hours after surgery and persists for several weeks, usually resolving completely. Other complications include a temporary Parinaud syndrome and pneumocephalus. A common complication of any surgery in the posterior fossa is aseptic meningitis. This can be alleviated with a short course of corticosteroids.
  • Complications of radiation therapy have been discussed previously and include lowered IQ, small stature, endocrine dysfunction, behavioral abnormalities, secondary neoplasms, and radiation necrosis of the white matter.
  • Chemotherapy also has numerous adverse effects on multiple organ systems including renal toxicity, ototoxicity, hepatotoxicity, pulmonary fibrosis, and gastrointestinal disturbance. Methotrexate, when used in combination with irradiation, can cause permanent necrotizing leukoencephalopathy.


See the list below:

  • Medulloblastoma is a very aggressive tumor. Even after a good response to surgery and radiation, recurrence is common; most recurrences occur within 2 years after treatment.
    • The most common location of recurrence is at the primary tumor site in the posterior fossa.
    • With the use of adjuvant chemotherapy, incidence of recurrence in the spinal canal and the supratentorial region seems to decrease.
  • Systemic metastases, in the absence of a CSF shunting system, are also a recognized problem in 10-20% of patients. Bone is the most common site of systemic metastasis; regional lymph node sites follow.
  • The Collin law was first hypothesized for Wilms tumor and has been expanded since to cover many pediatric tumors thought to be congenital in origin.
    • The Collin law states that, if a tumor has not recurred in a period of time equal to age of patient plus 9 months, that patient can be considered to be cured.
    • The Collin law generally holds for medulloblastoma; however, several late recurrences (longer than 10 years after diagnosis) have been reported. The 5-year progression-free survival rate in that group is 70-80% for patients at low risk and 60-70% for patients at high risk.
  • Greater age at diagnosis has been associated with a better prognosis, most likely because adults more often harbor the less aggressive desmoplastic variant of medulloblastoma.
  • Why females have a longer recurrence-free interval is not understood.

Patient Education

Teach patients and families about early signs of hydrocephalus, especially if the patient has a ventricular shunt in place.

Contributor Information and Disclosures

George I Jallo, MD Professor of Neurosurgery, Pediatrics, and Oncology, Director, Clinical Pediatric Neurosurgery, Department of Neurosurgery, Johns Hopkins University School of Medicine

George I Jallo, MD is a member of the following medical societies: American Association of Neurological Surgeons, American Medical Association, American Society of Pediatric Neurosurgeons

Disclosure: Received grant/research funds from Codman (Johnson & Johnson) for consulting; Received grant/research funds from Medtronic for consulting.


David A Chesler, MD, PhD Clinical and Research Fellow, Division of Pediatric Neurosurgery, Johns Hopkins University School of Medicine

David A Chesler, MD, PhD is a member of the following medical societies: American Association of Neurological Surgeons, American Medical Association, Congress of Neurological Surgeons

Disclosure: Nothing to disclose.

Faisal A Almayman, MBBS Post Doctorate Research Fellow, Department of Neurosurgery, Johns Hopkins University School of Medicine

Faisal A Almayman, MBBS is a member of the following medical societies: American Association of Neurological Surgeons, Saudi Stroke Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Kenneth J Mack, MD, PhD Senior Associate Consultant, Department of Child and Adolescent Neurology, Mayo Clinic

Kenneth J Mack, MD, PhD is a member of the following medical societies: American Academy of Neurology, Child Neurology Society, Phi Beta Kappa, Society for Neuroscience

Disclosure: Nothing to disclose.

Chief Editor

Amy Kao, MD Attending Neurologist, Children's National Medical Center

Amy Kao, MD is a member of the following medical societies: American Academy of Neurology, American Epilepsy Society, Child Neurology Society

Disclosure: Have stock from Cellectar Biosciences; have stock from Varian medical systems; have stock from Express Scripts.

Additional Contributors

Raj D Sheth, MD Chief, Division of Pediatric Neurology, Nemours Children's Clinic; Professor of Neurology, Mayo College of Medicine; Professor of Pediatrics, University of Florida College of Medicine

Raj D Sheth, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Pediatrics, American Epilepsy Society, American Neurological Association, Child Neurology Society

Disclosure: Nothing to disclose.


Alvin Marcovici, MD Consulting Staff, Southcoast Neurosurgery

Alvin Marcovici, MD is a member of the following medical societies: American Association of Neurological Surgeons, Congress of Neurological Surgeons, and Phi Beta Kappa

Disclosure: Nothing to disclose.

  1. Bailey P, Cushing H. A common type of midcerebellar glioma of childhood. Arch Neurol Psychiatr. 1925. 14:192-224.

  2. Salaroli R, Ronchi A, Buttarelli FR, Cortesi F, Marchese V, Bella ED, et al. Wnt activation affects proliferation, invasiveness and radiosensitivity in medulloblastoma. J Neurooncol. 2014 Sep 28. [Medline].

  3. Rorke LB. The cerebellar medulloblastoma and its relationship to primitive neuroectodermal tumors. J Neuropathol Exp Neurol. 1983 Jan. 42(1):1-15. [Medline].

  4. Bode U, Zimmermann M, Moser O, Rutkowski S, Warmuth-Metz M, Pietsch T, et al. Treatment of recurrent primitive neuroectodermal tumors (PNET) in children and adolescents with high-dose chemotherapy (HDC) and stem cell support: results of the HITREZ 97 multicentre trial. J Neurooncol. 2014 Sep 2. [Medline].

  5. Yamada A, Moritake H, Kamimura S, Yamashita S, Takeshima H, Nunoi H. Proposed strategy for the use of high-dose chemotherapy with stem cell rescue and intrathecal topotecan without whole-brain irradiation for infantile classic medulloblastoma. Pediatr Blood Cancer. 2014 Aug 30. [Medline].

  6. Rieken S, Mohr A, Habermehl D, Welzel T, Lindel K, Witt O, et al. Outcome and prognostic factors of radiation therapy for medulloblastoma. Int J Radiat Oncol Biol Phys. 2011 Nov 1. 81(3):e7-e13. [Medline].

  7. Gupta T, Jalali R, Goswami S, Nair V, Moiyadi A, Epari S, et al. Early Clinical Outcomes Demonstrate Preserved Cognitive Function in Children with Average-Risk Medulloblastoma When Treated with Hyperfractionated Radiation Therapy. Int J Radiat Oncol Biol Phys. 2012 Feb 16. [Medline].

  8. Haddy N, Mousannif A, Tukenova M, et al. Relationship between the brain radiation dose for the treatment of childhood cancer and the risk of long-term cerebrovascular mortality. Brain. 2011 May. 134:1362-72. [Medline].

  9. Martin AM, Raabe E, Eberhart C, Cohen KJ. Management of Pediatric and Adult Patients with Medulloblastoma. Curr Treat Options Oncol. 2014 Sep 7. [Medline].

  10. Adamski J, Ramaswamy V, Huang A, Bouffet E. Advances in managing medulloblastoma and intracranial primitive neuro-ectodermal tumors. F1000Prime Rep. 2014. 6:56. [Medline]. [Full Text].

  11. Albright AL, Wisoff JH, Zeltzer PM, Boyett JM, Rorke LB, Stanley P. Effects of medulloblastoma resections on outcome in children: a report from the Children's Cancer Group. Neurosurgery. 1996 Feb. 38(2):265-71. [Medline].

  12. Allen JC, Epstein F. Medulloblastoma and other primary malignant neuroectodermal tumors of the CNS. The effect of patients' age and extent of disease on prognosis. J Neurosurg. 1982 Oct. 57(4):446-51. [Medline].

  13. Ater JL, van Eys J, Woo SY, et al. MOPP chemotherapy without irradiation as primary postsurgical therapy for brain tumors in infants and young children. J Neurooncol. 1997 May. 32(3):243-52. [Medline].

  14. Bailey CC, Gnekow A, Wellek S, et al. Prospective randomised trial of chemotherapy given before radiotherapy in childhood medulloblastoma. International Society of Paediatric Oncology (SIOP) and the (German) Society of Paediatric Oncology (GPO): SIOP II. Med Pediatr Oncol. 1995 Sep. 25(3):166-78. [Medline].

  15. Balter-Seri J, Mor C, Shuper A, et al. Cure of recurrent medulloblastoma: the contribution of surgical resection at relapse. Cancer. 1997 Mar 15. 79(6):1241-7. [Medline].

  16. Blaser SI, Harwood-Nash DC. Neuroradiology of pediatric posterior fossa medulloblastoma. J Neurooncol. 1996 Jul. 29(1):23-34. [Medline].

  17. Carrie C, Muracciole X, Gomez F, et al. Conformal radiotherapy, reduced boost volume, hyperfractionated radiotherapy, and online quality control in standard-risk medulloblastoma without chemotherapy: results of the French M-SFOP 98 protocol. Int J Radiat Oncol Biol Phys. 2005 Nov 1. 63(3):711-6. [Medline].

  18. Chang CH, Housepian EM, Herbert C. An operative staging system and a megavoltage radiotherapeutic technic for cerebellar medulloblastomas. Radiology. 1969 Dec. 93(6):1351-9. [Medline].

  19. Cohen BH, Packer RJ. Chemotherapy for medulloblastomas and primitive neuroectodermal tumors. J Neurooncol. 1996 Jul. 29(1):55-68. [Medline].

  20. Dennis M, Spiegler BJ, Hetherington CR, et al. Neuropsychological sequelae of the treatment of children with medulloblastoma. J Neurooncol. 1996 Jul. 29(1):91-101. [Medline].

  21. Dufour C1, Kieffer V, Varlet P, Raquin MA, Dhermain F, Puget S, et al. Tandem high-dose chemotherapy and autologous stem cell rescue in children with newly diagnosed high-risk medulloblastoma or supratentorial primitive neuro-ectodermic tumors. [Full Text].

  22. Dunkel IJ, Boyett JM, Yates A, Rosenblum M, Garvin JH Jr, Bostrom BC, et al. High-dose carboplatin, thiotepa, and etoposide with autologous stem-cell rescue for patients with recurrent medulloblastoma. Children's Cancer Group. J Clin Oncol. 1998 Jan. 16(1):222-8. [Medline].

  23. Friedberg MH, David O, Adelman LS. Recurrence of medulloblastoma: violation of Collins' law after two decades. Surg Neurol. 1997 Jun. 47(6):571-4. [Medline].

  24. Giordana MT, Cavalla P, Dutto A, et al. Is medulloblastoma the same tumor in children and adults?. J Neurooncol. 1997 Nov. 35(2):169-76. [Medline].

  25. Giordana MT, Migheli A, Pavanelli E. Isochromosome 17q is a constant finding in medulloblastoma. An interphase cytogenetic study on tissue sections. Neuropathol Appl Neurobiol. 1998 Jun. 24(3):233-8. [Medline].

  26. Giordana MT, Schiffer P, Schiffer D. Prognostic factors in medulloblastoma. Childs Nerv Syst. 1998 Jun. 14(6):256-62. [Medline].

  27. Giralt J, Sánchez de Toledo J, Moraga F, et al. Improving survival of medulloblastoma: results in two groups of patients. Oncology. 1996 Jan-Feb. 53(1):38-42. [Medline].

  28. Hutzen B, Bid HK, Houghton PJ, Pierson CR, Powell K, Bratasz A, et al. Treatment of medulloblastoma with oncolytic measles viruses expressing the angiogenesis inhibitors endostatin and angiostatin. March,19,2014. [Full Text].

  29. Hye Sook Min,* Ji Yeoun Lee,† Seung-Ki Kim,† and Sung-Hye Park*‡. Genetic Grouping of Medulloblastomas by Representative Markers in Pathologic Diagnosis1. [Full Text].

  30. Jenkin D. The radiation treatment of medulloblastoma. J Neurooncol. 1996 Jul. 29(1):45-54. [Medline].

  31. Kiltie AE, Lashford LS, Gattamaneni HR. Survival and late effects in medulloblastoma patients treated with craniospinal irradiation under three years old. Med Pediatr Oncol. 1997 May. 28(5):348-54. [Medline].

  32. Kool M1, Korshunov A, Pfister SM. Update on molecular and genetic alterations in adult medulloblastoma. Sep 5,2012. [Full Text].

  33. Miralbell R, Bieri S, Huguenin P, et al. Prognostic value of cerebrospinal fluid cytology in pediatric medulloblastoma. Swiss Pediatric Oncology Group. Ann Oncol. 1999 Feb. 10(2):239-41. [Medline].

  34. Parsons DW1, Li M, Zhang X, Jones S, Leary RJ, Lin JC, et al. The genetic landscape of the childhood cancer medulloblastoma. [Full Text].

  35. Pollack IF, Polinko P, Albright AL, et al. Mutism and pseudobulbar symptoms after resection of posterior fossa tumors in children: incidence and pathophysiology. Neurosurgery. 1995 Nov. 37(5):885-93. [Medline].

  36. Rajurkar M1, Huang H, Cotton JL, Brooks JK, Sicklick J, McMahon AP, et al. Distinct cellular origin and genetic requirement of Hedgehog-Gli in postnatal rhabdomyosarcoma genesis. [Full Text].

  37. Rossi A, Caracciolo V, Russo G, Reiss K, Giordano A. Medulloblastoma: from molecular pathology to therapy. Clin Cancer Res. 2008 Feb 15. 14(4):971-6. [Medline].

  38. Rutka JT, Hoffman HJ. Medulloblastoma: a historical perspective and overview. J Neurooncol. 1996 Jul. 29(1):1-7. [Medline].

  39. Saran FH, Driever PH, Thilmann C, et al. Survival of very young children with medulloblastoma (primitive neuroectodermal tumor of the posterior fossa) treated with craniospinal irradiation. Int J Radiat Oncol Biol Phys. 1998 Dec 1. 42(5):959-67. [Medline].

  40. Schmandt S, Kuhl J. Chemotherapy as prophylaxis and treatment of meningosis in children less than 3 years of age with medulloblastoma. J Neurooncol. 1998 Jun-Jul. 38(2-3):187-92. [Medline].

  41. Sure U, Berghorn WJ, Bertalanffy H. Collins' law. Prediction of recurrence or cure in childhood medulloblastoma?. Clin Neurol Neurosurg. 1997 May. 99(2):113-6. [Medline].

  42. Sutton LN, Phillips PC, Molloy PT. Surgical management of medulloblastoma. J Neurooncol. 1996 Jul. 29(1):9-21. [Medline].

  43. Tomita T. Medulloblastomas. Youmans JR, ed. Neurolgical Surgery. 5th ed. Philadelphia: WB Saunders; 1996. Vol 4: 2570-92.

  44. Weil MD, Lamborn K, Edwards MS, Wara WM. Influence of a child's sex on medulloblastoma outcome. JAMA. 1998 May 13. 279(18):1474-6. [Medline].

  45. Weitman DM, Cogen PH. Contemporary management of medulloblastoma. Contemporary Neurosurgery. 1998. 20(2):1-8.

  46. Whelan HT, Krouwer HG, Schmidt MH, et al. Current therapy and new perspectives in the treatment of medulloblastoma. Pediatr Neurol. 1998 Feb. 18(2):103-15. [Medline].

  47. Whittier KL1, Boese EA, Gibson-Corley KN, Kirby PA, Darbro BW, Qian Q, et al. G-protein coupled receptor expression patterns delineate medulloblastoma subgroups. Oct,10,2013. [Full Text].

  48. Yang SY, Wang KC, Cho BK, et al. Radiation-induced cerebellar glioblastoma at the site of a treated medulloblastoma: case report. J Neurosurg. 2005 May. 102(4 Suppl):417-22. [Medline].

  49. Zeltzer PM, Boyett JM, Finlay JL, Albright AL, Rorke LB, Milstein JM, et al. Metastasis stage, adjuvant treatment, and residual tumor are prognostic factors for medulloblastoma in children: conclusions from the Children's Cancer Group 921 randomized phase III study. J Clin Oncol. 1999 Mar. 17(3):832-45. [Medline].

CT scan demonstrates a hyperdense lesion within the posterior fossa of an 8-year-old boy who presented with nausea and vomiting.
T1-weighted sagittal MRI of an 8-year-old boy who presented with nausea and vomiting reveals an enhancing tumor within the fourth ventricle. The child underwent a suboccipital craniotomy and resection of his medulloblastoma.
T1-weighted sagittal MRI of 4-year-old boy who presented with gait ataxia and precocious puberty. MRI shows a heterogenous enhancing tumor located within the fourth ventricle with marked hydrocephalus.
T1-weighted axial MRI shows heterogeneous enhancement of the medulloblastoma in a 4-year-old boy who presented with gait ataxia and precocious puberty.
Coronal MRI confirms the presence of the tumor within the fourth ventricle of a 4-year-old boy who presented with gait ataxia and precocious puberty.
High-power magnification hematoxylin and eosin (H&E) section of a typical medulloblastoma
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