Published online: 23 June 2001 © Springer-Verlag 2001 This commentary refers to the article http://dx.doi.org/10.1007/s003810100446 uniform enhancement on contrast ad- ministration are very characteristic of a medulloblastoma. However, in every study, variations in location, morphology and imaging have been seen. Desmoblastic lesions are often laterally placed, almost entirely within the cerebellum, and can be to- tally excised. However, their clinical behaviour remains the same, the in- cidence of recurrence being the same even after craniospinal irradiation. Frontal metastasis and intramedullary deposits are not unknown – we have had two cases of diffuse leptomeningeal spread with signifi- cant lesions subfrontally. One of our patients had cervical and the other an intramedullary deposit in the conus. Though we have been lucky in not having any intraabdominal spread even after VP shunt insertion, a good case can be made out for en- doscopic third ventriculostomy in- stead of shunt insertion. We have used chemotherapy as an adjunctive treatment, but are not convinced as yet of its utility. Its use is very risky in a country such as ours, where patients come from far distant regions and in some cases from a rural set-up in which intercur- rent infection can quickly take its toll as the white cell count drops sig- nificantly with chemotherapy. S.N. Bhagwati ( ✉ ) Department of Neurosurgery, Medical Research Centre, Bombay Hospital, 12, Marine Lines, Bombay 400 020, India e-mail: [email protected] Fax: +91-22-2080871 Child's Nerv Syst (2001) 17:543 DOI 10.1007/s003810100447 COMMENTARY Sanat N. Bhagwati Uncommon presentation of medulloblastoma Several studies including an analysis of patients with medulloblastoma have shown that the features of a mass arising from the vermis, splay- ing the cerebellar tonsils and filling up the fourth ventricle and showing

Uncommon presentation of medulloblastoma

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Page 1: Uncommon presentation of medulloblastoma

Published online: 23 June 2001© Springer-Verlag 2001

This commentary refers to the articlehttp://dx.doi.org/10.1007/s003810100446

uniform enhancement on contrast ad-ministration are very characteristicof a medulloblastoma. However, inevery study, variations in location,morphology and imaging have beenseen. Desmoblastic lesions are oftenlaterally placed, almost entirelywithin the cerebellum, and can be to-tally excised. However, their clinicalbehaviour remains the same, the in-cidence of recurrence being the sameeven after craniospinal irradiation.

Frontal metastasis and intramed-ullary deposits are not unknown –we have had two cases of diffuseleptomeningeal spread with signifi-cant lesions subfrontally. One of ourpatients had cervical and the other anintramedullary deposit in the conus.

Though we have been lucky innot having any intraabdominal

spread even after VP shunt insertion,a good case can be made out for en-doscopic third ventriculostomy in-stead of shunt insertion.

We have used chemotherapy as anadjunctive treatment, but are notconvinced as yet of its utility. Its useis very risky in a country such asours, where patients come from fardistant regions and in some casesfrom a rural set-up in which intercur-rent infection can quickly take itstoll as the white cell count drops sig-nificantly with chemotherapy.

S.N. Bhagwati (✉ )Department of Neurosurgery, Medical Research Centre, Bombay Hospital, 12, Marine Lines, Bombay 400 020, Indiae-mail: [email protected]: +91-22-2080871

Child's Nerv Syst (2001) 17:543DOI 10.1007/s003810100447 C O M M E N TA RY

Sanat N. Bhagwati

Uncommon presentation of medulloblastoma

Several studies including an analysisof patients with medulloblastomahave shown that the features of amass arising from the vermis, splay-ing the cerebellar tonsils and fillingup the fourth ventricle and showing