• Medulloblastomas

Medulloblastomas are Embryonal tumors that arise from the superior region of the vermis. This malignant brain tumor accounts for up to 30 - 40% of pediatric posterior fossa tumors. It is one of the treatable cancers. They appear clinically with headaches, projectile vomiting, and gait abnormalities. The neuroectodermal primitive cells suffer overproliferation and lineage change as a result of the gene mutations or related condition, resulting in fast tumor development. They develop quickly and initially exhibit signs of elevated intracranial pressure and obstructive hydrocephalus. MRI is chosen because it distinguishes the subarachnoid space from the fourth ventricle better than CT.

We have always felt more accountable, especially when dealing with children's posterior fossa tumors, because surgery and the degree of excision considerably impact prognosis. When taking a seat to analyse the photographs, we can roughly identify the tumor's features. They are frequently hyperintense to grey matter, with cyst development and surrounding edema seen on MRI T2 and FLAIR sequences. They also exhibit heterogeneous augmentation in T1 contrast, with WNT activated tumors enhancing brightly and Group 4 exhibiting little enhancement and evident limited diffusion.

Once we have determined that the radiological presentation favors medulloblastoma, bleeding associated with it is always kept in mind due to the tumor's vascular nature. A Midline suboccipital craniotomy will usually make the job easier. They are easily suckable and soft since they develop from embryonic tissues. Unless there is clear infiltration into the floor of the 4th ventricle, we always opt for gross complete excision. Only then should a thin sleeve be left over the floor to protect the cerebral nuclei. Once the mass is removed, the CSF route is restored, and practically every symptom of obstructive hydrocephalus and elevated intracranial pressure is alleviated. However, the postoperative difficulties are only beginning due to cerebellar mutism and ataxia. It is critical to educate the family about the transient nature of the initial postoperative alterations. These do, in fact, resolve with time. If the floor of the fourth ventricle is affected, 6th or 7th Cranial Nerve paralysis, as well as swallowing problems, are known to be undesired by-products. As a result, it is critical to keep the accompanying adverse effects in mind during excision.

Over time, pathologic categorization has shifted to molecular subtype, providing more insight into long-term prognosis. WHO has defined four categories: WNT, SHH, Group 3, and Group 4. It is the job of the surgeon to ensure that not too much of the tumor sample is sucked away during irrigation and reaches the pathologist. Because the risk grading for the next therapy is determined not only by the presence of residual disease larger than 1.5 cm in the tumor bed or metastasis at the time of diagnosis, but also by the molecular result. The advantages of surgical excision are enhanced by the addition of radiation, generally encompassing the Cranio-spinal Axis, combined with chemotherapy. Recent research indicates that proton beam therapy is considerably superior to phototherapy in terms of preventing bone marrow impairment and minimizing radiation spillover to surrounding organs. A successful surgical excision and adjuvant chemo-radiation treatment can enhance 5-year survival by 73%, while 10-year survival improves to 65% in the majority of patients.