Cerebellum tumors should be examined under two separate headings as adults and childhood.
Approximately 70-75% of adult brain tumors are located in the brain, while 60-70% of childhood brain tumors are located in the cerebellum. In other words, 2/3 of all adult brain tumors are seen in the brain, while 2/3 of childhood brain tumors are seen in the cerebellum.
While the most common brain tumor in adults is glial tumors (astrocytomas), the most common cerebellum tumor is hemangioblastomas, whose genetic transition is well known.
The most common tumor after childhood leukemia is cerebellum tumors. The most common among childhood cerebellum tumors (medulloblastoma, astrocytoma, epandioma, brain stem gliomas, dermoid and epidermoid cysts, etc.).
Among adult cerebellar tumors, the most common ones especially in the ponto-cerebellar corner region in adults (Schwannoma, meningioma, arachnoid and epidermoid cysts, plasmacytomas, glomus jugulare tumors, cerebellum metastases, etc.)
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Medulloblastomas, known since 1925, are a highly malignant cerebellar tumor type with very distinct cellular and clinical features.
It is the most common tumor of the cerebellum, constituting 4-10% of all primary brain tumors. However, they constitute 15-20% of childhood tumors. It is reported in the reports that the male female ratio is slightly higher in males, such as 4/3 or 2/1. While it is frequently seen in the first 10 years of life, 70% of all medulloblastomas are seen in children younger than 8 years old, but they are seen at any age from newborn to 70’s. Desmoplastic medulloblastomas, which are a separate subgroup of medulloblastomas, are seen in older children, such as people over 20 years of age. Classically, medulloblastomas are a midline tumor of the cerebellum originating from the middle part of the cerebellum or the roof of the 4 ventricles, while desmoplastic medulloblastomas are located more laterally, that is, in the hemispheres of the cerebellum. Medulloblastomas are histopathologically high cellular density tumors with small cytoplasm and oval hyperchromatic nuclei.
Since medulloblastomas are clinically midline tumors, increased intracranial pressure (CIBA) develops secondary to hydrocephalus because it prevents the flow of cerebrospinal fluid (CSF) in the 4th ventricle. Headache without nausea and almost gushing vomiting starts early in the morning and is the leading complaint that wakes children up from sleep. These precursor complaints then become persistent and persistent, leading children to neurosurgeons. Headache and vomiting complaints are followed by double vision 6 and 4 cranial nerve palsies due to increased intracranial pressure. In addition, balance and coordination disorders, which are the main functions of the cerebellum, are observed. In neurological examination, papilledema occurs especially due to CIBA, and sometimes they are examined in ophthalmology clinics of hospitals with vision loss and eyeball shifts. In addition to these, imbalance (ataxia), nystagmus, cranial nerve palsies are seen.
Diagnosis
As in all cerebellar tumors, medicated brain magnetic resonance (MR) technique, one of the brain imaging methods, is a very important and reliable non-invasive test method in the diagnosis of these lesions. In addition, medicated brain Computed Tomography (CT) technique provides additional information to MR technique in tumors such as some cerebellum tumors (eg ependymoma). Test methods such as cerebrovascular angiography have no place in the diagnosis of these lesions. However, in cases where the surgeon is thought to have a vascular lesion, cerebrovascular angiography test may be necessary. As a result, when the cerebellum tumor is considered, the diagnosis is made very quickly and quickly thanks to today’s advanced diagnostic technologies. Unfortunately, there are no tests for tumor markers from blood or CSF in the diagnosis of medulloblastomas located in the cerebellum.
Treatment:
As with all cerebellum tumors, if the neurosurgeon thinks that the lesion in the cerebellum is medulloblastoma in the preoperative period, if the patient has time for adequate treatment (risk of herniation), these lesions can spread through the CSF throughout the cranio-spinal spinal cord. It is important to examine such individuals in terms of the spread of the entire spinal canal. In planning the treatment of these lesions, first of all, gross total resection of the lesion should be performed, if possible. An experienced neurosurgeon plans the surgery by knowing where such a lesion originates and where it grows during cerebellum surgery. Because the vital functions of all anatomical tissues are very important during surgery for cerebellum tumors. While it is important to remove only the entire lesion, it is also important to correct the CSF flow in the 4th ventricle. In addition, it is important that there are nuclei of very important cranial nerves in the normal anatomical tissues during the operation of this lesion. After the complete lesion is taken and the histopathological report is confirmed as medulloblastoma, oncological treatment (if the child’s age is appropriate (radiotherapy and chemotherapy)) should be given additional oncological treatments in the second stage of the treatment. Here, the question of whether this lesion has spread to the entire spinal canal should be answered.
In conclusion
These tumors are malignant tumors of childhood. Unfortunately, they are malignant in character. Headache, vomiting, ocular nerve complaints are evident. Only medicated brain MRI technique is sufficient for their diagnosis. Oncological treatments are required after a cerebellum surgery to remove the entire tumour. There is no surgical mortality in my cerebellum medulloblastoma surgeries in recent years. 5-year survival time varies between 25-70%. 5-year survival is expected to be 60% in children older than 2 years of age who undergo total excision and receive radiotherapy. However, cases with a longer survival time have been reported in recent years. has grown.
