Myelography in the assessment of children with medulloblastoma

The clinical and surgical aspects of spinal tumors in children

A series of 20 pediatric patients underwent surgery for spinal tumor at the Department of Neurosurgery, Gulhane Military Medical Academy between 1995 and 2003. Motor weakness and reflex changes were the main initial signs in these patients. Epidural tumors and intradural-extramedullary tumors were in equal number, and total tumor removal was achieved in most of the patients without adjuvant treatment. Laminotomy was the main surgical method in 60% of the patients with spinal tumor, especially in children younger than 3 years of age.

Medulloblastoma: is the 5-year survival rate improving? A review of 80 cases from a single institution

A series of 80 cases of medulloblastomas in children undergoing operation and postoperatively followed between 1980 and 1990 at Great Ormond Street Hospital for Children (GOSH) has been reviewed and compared to an earlier series reported from the same institution by McIntosh. The overall 5-year survival rate for the present series was 50%, although three patients died after surviving 5 years. The operative mortality rate was 5%. Survival analysis revealed that the presence or absence of spinal metastases and the necessity for some form of cerebrospinal fluid diversion within 30 days of the operation independently significantly affected survival in this series. Those patients with no spinal metastasis and total tumor removal had a 5-year survival rate of 73%, making this the most favorable subgroup in the series. Patient age and gender, duration of symptoms, Chang T stages, tumor volume, extent of resection, and postoperative chemotherapy were not significant variables. Although these results are better than those reported in the earlier GOSH series, they are not significantly different from the results of the second 5-year cohort of patients described in that article. Radiotherapy remains the greatest advance in treatment, although it is hoped that further improvement will result from the various chemotherapy protocols now being studied and from increasing knowledge of the biological behavior of these tumors.

Intracranial ependymomas in childhood: a report of 24 cases followed for 5 years

The management and outcome of 24 patients with intracranial ependymomas admitted to our institution between January 1979 and May 1988 have been analysed. Four patients out of the ten with infratentorial ependymomas who underwent a visible total resection were alive and free of disease at 5 years, whereas all those who had had an incomplete resection were dead. The prognosis in the supratentorial group was worse; only one patient out of seven was alive and free of disease at 5 years. Nine patients (six infratentorial and three supratentorial ependymomas) were investigated with myelography for occult spinal metastases, and apart from one who had a direct extension of an infratentorial tumour into the upper cervical spine, none had detectable metastases. Eight patients with infratentorial tumours underwent a ventriculo-peritoneal shunt insertion, and in three of them this followed a visible total resection of the tumour. Comparison of our results with those from other series suggests that any improvement in outlook is related primarily to an increased number of children surviving their initial surgical treatment, rather than to better methods of postoperative tumour control.