Medulloblastoma Medication

  • Author: George I Jallo, MD; Chief Editor: Amy Kao, MD   more...
 
Updated: Mar 9, 2012
 

Medication Summary

Medulloblastoma is treated primarily with surgical excision followed by radiation therapy and chemotherapy. Few drugs are of benefit in this disease. Exceptions are glucocorticoids, which can aid in decreasing vasogenic edema. Mannitol is useful in the acute setting when the physician is faced with a herniating patient. Chemotherapy is used as adjuvant therapy in some patients. Administration of toxic compounds that affect multiple organ systems is in the realm of the experienced oncologist.

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Glucocorticoids

Class Summary

Reduction of vasogenic edema is the role of glucocorticoids in malignant brain tumors. They can be very effective in medulloblastoma and can even alleviate hydrocephalus by reopening CSF pathways in the posterior fossa. Although any of several glucocorticoids can be used, dexamethasone is used most often. Equivalent doses of various glucocorticoids are 0.75 mg for dexamethasone, 4 mg for methylprednisolone and triamcinolone, 5 mg for prednisolone and prednisone, 20 mg for hydrocortisone, and 25 mg for cortisone.

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Dexamethasone (Decadron, Dexasone)

 

Most commonly used drug to treat vasogenic edema secondary to medulloblastoma. Promotes reduction of edema after craniotomy.

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Methylprednisolone (Solu-Medrol, Depo-Medrol)

 

Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing increased capillary permeability.

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Prednisolone (AK-Pred, Delta-Cortef, Articulose-50, Econopred)

 

Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reducing capillary permeability.

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Prednisone (Sterapred)

 

May decrease inflammation by reversing increased capillary permeability and suppressing polymorphonuclear cell activity.

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Hydrocortisone (Solu-Cortef, Westcort)

 

Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing increased capillary permeability.

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Cortisone (Cortone acetate)

 

Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing increased capillary permeability.

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Diuretics

Class Summary

These agents are used in the acute setting to prevent further increases of intracranial pressure.

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Mannitol (Osmitrol)

 

May reduce subarachnoid space pressure by creating osmotic gradient between CSF in arachnoid space and plasma. Not for long-term use.

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Contributor Information and Disclosures
Author

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, and American Society of Pediatric Neurosurgeons

Disclosure: Codman (Johnson & Johnson) Grant/research funds Consulting; Medtronic Grant/research funds Consulting

Coauthor(s)

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.

Specialty Editor Board

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

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, and Child Neurology Society

Disclosure: Nothing to disclose.

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

Disclosure: Medscape Salary Employment

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, and 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 Academy of Pediatrics, American Epilepsy Society, and Child Neurology Society

Disclosure: Nothing to disclose.

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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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