Surgical outcome of children with medulloblastoma: a retrospective study of a 405-patient series from Children’s Cancer Hospital Egypt (CCHE-57357)



To analyze the impact of increasing the extent of resection (EOR) on the survival rates and on the surgical outcome of children with medulloblastoma.


A series of consecutive 405 children operated for medulloblastoma between July 2007 and April 2018 was identified. The details of pre-operative data, surgical interventions, post-operative complications, and survival rates were analyzed.


The Kaplan-Meier (KM) analysis showed no advantage of gross total resection (GTR) over near and subtotal resection regarding over all (OS) (p=0.557) and progression free survival (PFS) (p=0.146). In the same time, increasing the EOR was not associated with higher morbidity. Tumor dissemination at onset correlated to worse OS (KM: p=0.003, OR 1.999, 95% CI: 1.242–3.127; p = 0.004) and PFS (KM: p<0.001, Cox: OR 2.171, 95% CI: 1.406–3.353; p<0.001). OS was significantly affected in patients < 3 years old (KM: p=0.011, OR 2.036, 95% CI: 1.229–3.374; p = 0.006), while PFS was worse among patients who had pre-op seizures (KM: p=0.036, Cox: OR 2.852, 95% CI: 1.046–7.773; p=0.041) or post-op pseudomeningocele (KM: p=0.021, Cox: OR 2.311, 95% CI: 1.123–4.754; p=0.023).


Although surgical excision of medulloblastoma is the standard of care, there was no significant benefit for GTR over near or subtotal resection on the OS or PFS rates that are mainly influenced by the patient’s age and tumor dissemination. However, GTR should be targeted, as it is not associated with increased incidence of mutism or other surgery-related complications.

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  1. 1.

    Albright AL, Wisoff JH, Zeltzer PM, Boyett JM, Rorke LB, Stanley P (1996) Effects of medulloblastoma resections on outcome in children: a report from the Children’s Cancer Group. Neurosurgery 38(2):265–271

    CAS  PubMed  Article  Google Scholar 

  2. 2.

    Bognár L, Borgulya G, Benke P, Madarassy G (2003) Analysis of CSF shunting procedure requirement in children with posterior fossa tumors. Childs Nerv Syst 19(5-6):332–336

    PubMed  Article  Google Scholar 

  3. 3.

    Christopherson KM, Bradley JA, Rotondo RL, Pincus DW, Fort JA, Morris CG, Mendenhall NP, Marcus RB Jr, Indelicato DJ (2014) Local control in non-metastatic medulloblastoma. Acta Oncol 53(9):1151–1157

    CAS  PubMed  Article  Google Scholar 

  4. 4.

    de Robles P, Fiest KM, Frolkis AD, Pringsheim T, Atta C, St. Germaine-Smith C, Day L, Lam D, Jette N (2014) The worldwide incidence and prevalence of primary brain tumors: a systematic review and meta-analysis. Neuro-oncology 17(6):776–783

    PubMed  PubMed Central  Article  Google Scholar 

  5. 5.

    Di Rocco C, Chieffo D, Pettorini BL, Massimi L, Caldarelli M, Tamburrini G (2010) Preoperative and postoperative neurological, neuropsychological and behavioral impairment in children with posterior cranial fossa astrocytomas and medulloblastomas: the role of the tumor and the impact of the surgical treatment. Childs Nerv Syst 26(9):1173–1188

    PubMed  Article  Google Scholar 

  6. 6.

    Dressler EV, Dolecek TA, Liu M, Villano JL (2017) Demographics, patterns of care, and survival in pediatric medulloblastoma. J Neuro-Oncol 132(3):497–506

    Article  Google Scholar 

  7. 7.

    El Beltagy MA, Kamal HM, Taha H, Awad M, El Khateeb N (2010) Endoscopic third ventriculostomy before tumor surgery in children with posterior fossa tumors, CCHE experience. Childs Nerv Syst 26(12):1699–1704

    PubMed  Article  Google Scholar 

  8. 8.

    Fernández IS, Loddenkemper T (2017) Seizures caused by brain tumors in children. Seizure 44:98–107

    Article  Google Scholar 

  9. 9.

    Foreman P, McClugage S, Naftel R, Griessenauer CJ, Ditty BJ, Agee BS, Riva-Cambrin J, Wellons J (2013) Validation and modification of a predictive model of postresection hydrocephalus in pediatric patients with posterior fossa tumors. J Neurosurg Pediatr 12(3):220–226

    PubMed  Article  Google Scholar 

  10. 10.

    Gajjar A, Sanford RA, Bhargava R, Heideman R, Walter A, Li Y, Langston JW, Jenkins JJ, Muhlbauer M, Boyett J (1996) Medulloblastoma with brain stem involvement: the impact of gross total resection on outcome. Pediatr Neurosurg 25(4):182–187

    CAS  PubMed  Article  Google Scholar 

  11. 11.

    Gilles FH, Sobel E, Leviton A, Hedley-Whyte ET, Tavare CJ, Adelman LS, Sobel RA (1992) Epidemiology of seizures in children with brain tumors. J Neuro-Oncol 12(1):53–68

    CAS  Article  Google Scholar 

  12. 12.

    Gnekow A (1995) Recommendations of the Brain Tumor Subcommittee for the reporting of trials. Med Pediatr Oncol 24(2):104–108

    CAS  PubMed  Article  Google Scholar 

  13. 13.

    Grill MF, Treiman DM, Maganti RK (2009) Status epilepticus associated with subtentorial posterior fossa lesions. Arch Neurol 66(12):1500–1504

    PubMed  Article  Google Scholar 

  14. 14.

    Johnston DL, Keene D, Kostova M, Lafay-Cousin L, Fryer C, Scheinemann K, Carret A-S, Fleming A, Percy V, Afzal S (2015) Survival of children with medulloblastoma in Canada diagnosed between 1990 and 2009 inclusive. J Neuro-Oncol 124(2):247–253

    CAS  Article  Google Scholar 

  15. 15.

    Khan RB, Hunt DL, Boop FA, Sanford RA, Merchant TE, Gajjar A, Kun LE (2005) Seizures in children with primary brain tumors: incidence and long-term outcome. Epilepsy Res 64(3):85–91

    PubMed  Article  Google Scholar 

  16. 16.

    Kombogiorgas D, Sgouros S, Walsh A, Hockley A, Stevens M, Grundy R, Peet A, English M, Spooner D (2007) Outcome of children with posterior fossa medulloblastoma: a single institution experience over the decade 1994–2003. Childs Nerv Syst 23(4):399–405

    CAS  PubMed  Article  Google Scholar 

  17. 17.

    Lee ST, Lui TN, Chang CN, Cheng WC (1990) Early postoperative seizures after posterior fossa surgery. J Neurosurg 73(4):541–544

    CAS  PubMed  Article  Google Scholar 

  18. 18.

    Legnani FG, Saladino A, Casali C, Vetrano IG, Varisco M, Mattei L, Prada F, Perin A, Mangraviti A, Solero CL (2013) Craniotomy vs. craniectomy for posterior fossa tumors: a prospective study to evaluate complications after surgery. Acta Neurochir 155(12):2281–2286

    PubMed  Article  Google Scholar 

  19. 19.

    Lin CT, Riva-Cambrin JK (2015) Management of posterior fossa tumors and hydrocephalus in children: a review. Childs Nerv Syst 31(10):1781–1789.

    Article  PubMed  Google Scholar 

  20. 20.

    McNeil DE, Coté TR, Clegg L, Rorke LB (2002) Incidence and trends in pediatric malignancies medulloblastoma/primitive neuroectodermal tumor: a SEER update. Medical and Pediatric Oncology: The Official Journal of SIOP—International Society of Pediatric Oncology Societé Internationale d’Oncologie Pédiatrique 39(3):190–194

    Article  Google Scholar 

  21. 21.

    Morelli D, Pirotte B, Lubansu A, Detemmerman D, Aeby A, Fricx C, Berré J, David P, Brotchi J (2005) Persistent hydrocephalus after early surgical management of posterior fossa tumors in children: is routine preoperative endoscopic third ventriculostomy justified? J Neurosurg Pediatr 103(3):247–252

    Article  Google Scholar 

  22. 22.

    Özek MM, Cinalli G, Maixner WJ, Sainte-Rose C (2015) Posterior fossa tumors in children. Springer International Publishing, Cham

    Google Scholar 

  23. 23.

    Palesi F, Tournier J-D, Calamante F, Muhlert N, Castellazzi G, Chard D, D’Angelo E, Wheeler-Kingshott CA (2015) Contralateral cerebello-thalamo-cortical pathways with prominent involvement of associative areas in humans in vivo. Brain Struct Funct 220(6):3369–3384

    PubMed  Article  Google Scholar 

  24. 24.

    Polkinghorn WR, Tarbell NJ (2007) Medulloblastoma: tumorigenesis, current clinical paradigm, and efforts to improve risk stratification. Nat Rev Clin Oncol 4(5):295–304

    CAS  Article  Google Scholar 

  25. 25.

    Prasad KS, Ravi D, Pallikonda V, Raman BV (2017) Clinicopathological study of pediatric posterior fossa tumors. J Pediatr Neurosci 12(3):245–250

    PubMed  PubMed Central  Article  Google Scholar 

  26. 26.

    Ramaswamy V, Remke M, Adamski J, Bartels U, Tabori U, Wang X, Huang A, Hawkins C, Mabbott D, Laperriere N (2015) Medulloblastoma subgroup-specific outcomes in irradiated children: who are the true high-risk patients? Neuro-oncology 18(2):291–297

    PubMed  PubMed Central  Article  Google Scholar 

  27. 27.

    Rieken S, Mohr A, Habermehl D, Welzel T, Lindel K, Witt O, Kulozik AE, Wick W, Debus J, Combs SE (2011) Outcome and prognostic factors of radiation therapy for medulloblastoma. Int J Radiat Oncol Biol Phys 81(3):e7–e13

    PubMed  Article  Google Scholar 

  28. 28.

    Robertson PL, Muraszko KM, Holmes EJ, Sposto R, Packer RJ, Gajjar A, Dias MS, Allen JC (2006) Incidence and severity of postoperative cerebellar mutism syndrome in children with medulloblastoma: a prospective study by the Children’s Oncology Group. J Neurosurg Pediatr 105(6):444–451

    Article  Google Scholar 

  29. 29.

    Ruggiero C, Cinalli G, Spennato P, Aliberti F, Cianciulli E, Trischitta V, Maggi G (2004) Endoscopic third ventriculostomy in the treatment of hydrocephalus in posterior fossa tumors in children. Childs Nerv Syst 20(11-12):828–833

    PubMed  Article  Google Scholar 

  30. 30.

    Schneider C, Ramaswamy V, Kulkarni AV, Rutka JT, Remke M, Tabori U, Hawkins C, Bouffet E, Taylor MD (2015) Clinical implications of medulloblastoma subgroups: incidence of CSF diversion surgery. 15(3):236.

  31. 31.

    Stavrou T, Bromley CM, Nicholson HS, Byrne J, Packer RJ, Goldstein AM, Reaman GH (2001) Prognostic factors and secondary malignancies in childhood medulloblastoma. J Pediatr Hematol Oncol 23(7):431–436

    CAS  PubMed  Article  Google Scholar 

  32. 32.

    Steinbok P, Singhal A, Mills J, Cochrane D, Price A (2007) Cerebrospinal fluid (CSF) leak and pseudomeningocele formation after posterior fossa tumor resection in children: a retrospective analysis. Childs Nerv Syst 23(2):171–174

    CAS  PubMed  Article  Google Scholar 

  33. 33.

    Stensvold E, Krossnes BK, Lundar T, Due-Tønnessen BJ, Frič R, Due-Tønnessen P, Bechensteen AG, Myklebust TÅ, Johannesen TB, Brandal P (2017) Outcome for children treated for medulloblastoma and supratentorial primitive neuroectodermal tumor (CNS-PNET)–a retrospective analysis spanning 40 years of treatment. Acta Oncol 56(5):698–705

    PubMed  Article  Google Scholar 

  34. 34.

    Tamburrini G, Frassanito P, Chieffo D, Massimi L, Caldarelli M, Di Rocco C (2015) Cerebellar mutism. Childs Nerv Syst 31(10):1841–1851

    CAS  PubMed  Article  Google Scholar 

  35. 35.

    Taylor RE, Bailey CC, Robinson K, Weston CL, Ellison D, Ironside J, Lucraft H, Gilbertson R, Tait DM, Walker DA (2003) Results of a randomized study of preradiation chemotherapy versus radiotherapy alone for nonmetastatic medulloblastoma: The International Society of Paediatric Oncology/United Kingdom Children’s Cancer Study Group PNET-3 Study. J Clin Oncol 21(8):1581–1591

    CAS  PubMed  Article  Google Scholar 

  36. 36.

    Thompson EM, Hielscher T, Bouffet E, Remke M, Luu B, Gururangan S, McLendon RE, Bigner DD, Lipp ES, Perreault S (2016) Prognostic value of medulloblastoma extent of resection after accounting for molecular subgroup: a retrospective integrated clinical and molecular analysis. Lancet Oncol 17(4):484–495

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  37. 37.

    Tomasello F, Conti A, Cardali S, La Torre D, Angileri FF (2015) Telovelar approach to fourth ventricle tumors: highlights and limitations. World Neurosurg 83(6):1141–1147

    PubMed  Article  Google Scholar 

  38. 38.

    Ullrich NJ, Pomeroy SL, Kapur K, Manley PE, Goumnerova LC, Loddenkemper T (2015) Incidence, risk factors, and longitudinal outcome of seizures in long-term survivors of pediatric brain tumors. Epilepsia 56(10):1599–1604

    PubMed  Article  Google Scholar 

  39. 39.

    Warmuth-Metz M, Blashofer S, von Bueren AO, von Hoff K, Bison B, Pohl F, Kortmann R-D, Pietsch T, Rutkowski S (2011) Recurrence in childhood medulloblastoma. J Neuro-Oncol 103(3):705–711

    Article  Google Scholar 

  40. 40.

    Weil AG, Wang AC, Westwick HJ, Ibrahim GM, Ariani RT, Crevier L, Perreault S, Davidson T, Tseng C-H, Fallah A (2017) Survival in pediatric medulloblastoma: a population-based observational study to improve prognostication. J Neuro-Oncol 132(1):99–107

    Article  Google Scholar 

  41. 41.

    Wibroe M, Rochat P, Juhler M (2018) Cerebellar mutism syndrome and other complications after surgery in the posterior fossa in adults: a prospective study. World Neurosurg 110:e738–e746

    PubMed  Article  Google Scholar 

  42. 42.

    Yu J, Shi W, Li H (2017) Factors affecting the prognosis of children with medulloblastoma: a single institution retrospective analysis of 40 cases. Transl Neurosci Clinics 3(1):16–27

    Article  Google Scholar 

  43. 43.

    Zeltzer PM, Boyett JM, Finlay JL, Albright AL, Rorke LB, Milstein JM, Allen JC, Stevens KR, Stanley P, Li H (1999) 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 17(3):832–845

    CAS  PubMed  Article  Google Scholar 

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Correspondence to Mohamed A. El Beltagy.

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Enayet, A.E., Nabil, M., Rady, M.R. et al. Surgical outcome of children with medulloblastoma: a retrospective study of a 405-patient series from Children’s Cancer Hospital Egypt (CCHE-57357). Childs Nerv Syst (2021).

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  • Medulloblastoma
  • Mutism
  • Pseudomeningocele
  • Hydrocephalous with posterior fossa tumors