eMedicine Specialties > Neurosurgery > Neoplasm

Posterior Fossa Tumors: Follow-up

Author: Hassan Ahmad Hassan Al-Shatoury, MD, PhD, MHPE, Assistant Professor, Department of Neurosurgery, Suez Canal University; Co-Director, Center of Research and Development in Medical Education and Health Services Suez Canal University Hospital
Coauthor(s): Ayman Ali Galhom, MD, PhD, Fellow, Department of Neurosurgery, University of Mississippi Medical Center; Herbert H Engelhard III, MD, PhD, Director, UIC Neuro-Oncology Program, Chief, Division of Neuro-Oncology, Associate Professor, Department of Neurosurgery, University of Illinois at Chicago
Contributor Information and Disclosures

Updated: Feb 5, 2008

Outcome and Prognosis

  • The 5-year survival rates exceed 60% for all patients and 80% for certain good-risk individuals with posterior fossa tumors.
  • In cases of pilocytic cerebellar astrocytoma, the 25-year survival rate exceeds 94%.6
  • Patients with medulloblastoma are classified into good-risk and bad-risk categories based on the following:
    • Age of presentation
    • Extension of surgical resection
    • Leptomeningeal dissemination or metastasis
  • Prognosis in medulloblastoma is worse for children younger than 2 years, for patients with subtotal resection (80%), and for those with subarachnoid metastasis or positive results on CSF cytology more than 2 weeks after surgery.
  • In patients with ependymomas, the 5-year survival rate is 20%.
  • In ependymoblastoma, the 5-year survival rate is only 6%.
  • Choroid plexus papilloma has excellent prognosis, as high as 100% survival rate.
  • Choroid plexus carcinoma has poor prognosis.

Future and Controversies

Future management

  • Stereotactic radiosurgery utilizes only the physical properties of the irradiation to deliver deadly radiation doses to the tumor.
  • Stereotactic radiotherapy benefits from the differences in radiobiological properties between normal and pathological tissue.
  • In interstitial brachytherapy, a radioactive material is implanted into the tumor bed at the time of surgery to deliver a continuous, localized dose of irradiation.
  • Chemotherapy with new therapeutic medications may have a role in the treatment of residual tumors after surgery.
  • Immunotherapy aims at activation of cell-mediated cytotoxic responses and humorally mediated cytotoxic response against the tumor cells. This is still investigational.

Special issues

An informed consent must be obtained from the patient if his or her general condition permits understanding the risks and potential benefits of surgery; otherwise, it must be obtained from relatives. The discussion related to the informed consent should include the following:

  • Summary of the nature of the condition and its presumed course without treatment
  • Description of the proposed surgical treatment
  • Possible complications that can occur as a result of surgery
  • Review of alternative treatment modalities, including a brief discussion of the pros and cons of each treatment
  • A statement that the operation is not guaranteed to improve the patient's condition
 


More on Posterior Fossa Tumors

Overview: Posterior Fossa Tumors
Workup: Posterior Fossa Tumors
Treatment: Posterior Fossa Tumors
Follow-up: Posterior Fossa Tumors
References
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References

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Further Reading

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Keywords

posterior fossa tumors, infratentorial tumors, brain stem tumors, cerebellar tumors, cerebellar medulloblastoma, medulloblastoma, pineoblastoma, ependymomas, primitive neuroectodermal tumors, PNETs, astrocytomas, glial tumors

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Contributor Information and Disclosures

Author

Hassan Ahmad Hassan Al-Shatoury, MD, PhD, MHPE, Assistant Professor, Department of Neurosurgery, Suez Canal University; Co-Director, Center of Research and Development in Medical Education and Health Services Suez Canal University Hospital
Disclosure: Nothing to disclose.

Coauthor(s)

Ayman Ali Galhom, MD, PhD, Fellow, Department of Neurosurgery, University of Mississippi Medical Center
Ayman Ali Galhom, MD, PhD is a member of the following medical societies: Congress of Neurological Surgeons
Disclosure: Nothing to disclose.

Herbert H Engelhard III, MD, PhD, Director, UIC Neuro-Oncology Program, Chief, Division of Neuro-Oncology, Associate Professor, Department of Neurosurgery, University of Illinois at Chicago
Herbert H Engelhard III, MD, PhD is a member of the following medical societies: American Association for Cancer Research, American Association of Neurological Surgeons, American College of Surgeons, American Medical Association, American Society for Cell Biology, American Society of Clinical Oncology, Chicago Medical Society, Congress of Neurological Surgeons, Illinois State Medical Society, Society for Neuro-Oncology, and Society for Neuroscience
Disclosure: Nothing to disclose.

Medical Editor

Michael G Nosko, MD, PhD, Chief, Division of Neurosurgery, Director of Neurovascular Surgery, Medical Director of Neuroscience Unit, Associate Professor, Department of Surgery, University of Medicine and Dentistry at New Jersey
Michael G Nosko, MD, PhD is a member of the following medical societies: Academy of Medicine of New Jersey, Alpha Omega Alpha, American Association of Neurological Surgeons, American College of Surgeons, American Heart Association, American Medical Association, New York Academy of Sciences, and Society of Critical Care Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Allen R Wyler, MD, Former Medical Director, Northstar Neuroscience, Inc
Allen R Wyler, MD is a member of the following medical societies: American Academy of Neurological and Orthopaedic Surgeons, American Association of Neurological Surgeons, and Society of Neurological Surgeons
Disclosure: Nothing to disclose.

CME Editor

Paolo Zamboni, MD, Professor of Surgery, Chief of Day Surgery Unit, Chair of Vascular Diseases Center, University of Ferrara, Italy
Paolo Zamboni, MD is a member of the following medical societies: American Venous Forum and New York Academy of Sciences
Disclosure: Nothing to disclose.

Chief Editor

Allen R Wyler, MD, Former Medical Director, Northstar Neuroscience, Inc
Allen R Wyler, MD is a member of the following medical societies: American Academy of Neurological and Orthopaedic Surgeons, American Association of Neurological Surgeons, and Society of Neurological Surgeons
Disclosure: Nothing to disclose.

 
 
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