Skip to main content
SpringerLink
Log in

Diffuse postoperative cerebellar swelling in medulloblastoma: report of two cases

  • Original Paper
  • Published:
Child's Nervous System Aims and scope Submit manuscript

Abstract

Background

We report two cases of diffuse cerebellar swelling with upward transtentorial herniation following medulloblastoma resection. We present our insight for managing medulloblastoma with aggressive clinical behavior.

Review summary

Case 1 is a 32-month-old boy. Magnetic resonance imaging (MRI) revealed fourth ventricular mass with diffuse leptomeningeal metastasis. He underwent gross total resectioning of the tumor and histopathology revealed a large cell medulloblastoma. A ventriculoperitoneal shunt was placed on the 25th postoperative day. Ten days after he developed lethargy, and MRI showed diffuse cerebellar swelling with upward herniation. He underwent emergent posterior fossa decompression; however, he remained unresponsive since then. Case 2 is a 31-month-old boy. MRI revealed a fourth ventricular mass with diffuse leptomeningeal metastasis. He underwent gross total resection and histopathology was a large cell medulloblastoma. Due to developing ventriculomegaly, extraventricular drainage was reinserted on the 11th postoperative day. Four days after, he developed lethargy and decerebrate posturing. MRI showed diffuse cerebellar swelling with upward herniation. He underwent aggressive posterior fossa decompression. Chemotherapy was started postoperatively. Gradually, his movement of extremities improved. On the 79th postoperative day, he started to follow commands and talk some words. He was discharged to a rehabilitation institute and has continued to improve since then.

Conclusion

Diffuse cerebellar swelling with upward herniation could occur in patients with aggressive medulloblastoma postoperatively. Our patients had diffuse leptomeningeal dissemination of the tumor at the initial presentation. Close monitoring and prompt diagnosis with earlier surgical posterior fossa decompression and administration of chemotherapy may prevent irreversible neurologic deterioration.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Brown HG, Kepner JL, Perlman EJ et al (2000) “Large cell/anaplastic” medulloblastomas: a Pediatric Oncology Group Study. J Neuropathol Exp Neurol 59:857–865

    PubMed  CAS  Google Scholar 

  2. Davis FG, Freels S, Grutsch J, Barlas S, Brem S (1998) Survival rates in patients with primary brain tumors stratified by patient age and tumor histological type: an analysis based on Surveillance, Epidemiology and End Results (SEER) data, 1973–1991. J Neurosurg 88:1–10

    Article  PubMed  CAS  Google Scholar 

  3. David KF, Casey ATH, Hayward RD, Harkness WFJ, Phipps K, Wade AM (1997) Medulloblastoma: is the 5-year survival rate improving?—A review of 80 cases from a single institution. J Neurosurg 86:13–21

    Article  PubMed  CAS  Google Scholar 

  4. Gajjar A, Chintagumpala M, Ashley D et al (2006) Risk-adapted craniospinal radiotherapy followed by high-dose chemotherapy and stem-cell rescue in children with newly diagnosed medulloblastoma (St. Jude Medulloblastoma-96): long-term results from a prospective, multicentre trial. Lancet Oncol 10:813–820

    Article  Google Scholar 

  5. Ishihara H, Kubota H, Lindberg RL et al (2008) Endothelial cell barrier impairment induced by glioblastomas and transforming growth factor beta2 involves matrix metalloproteinases and tight junction proteins. J Neuropathol Exp Neurol 67:435–448

    Article  PubMed  CAS  Google Scholar 

  6. Papadopoulos MC, Saadoun S, Binder DK, Manley GT, Krishna S, Verkman AS (2004) Molecular mechanisms of brain tumor edema. Neuroscience 129:1011–1020

    Article  PubMed  CAS  Google Scholar 

  7. Strugar J, Rothbart D, Harrington W, Criscuolo GR (1994) Vascular permeability factor in brain metastases: correlation with vasogenic brain edema and tumor angiogenesis. J Neurosurg 81:560–566

    Article  PubMed  CAS  Google Scholar 

  8. Taylor RE, Bailey CC, Robinson KJ et al (2005) Outcome of patients with metastatic (M2-3) medulloblastoma treated with SIOP/UKCCSG PNET III chemotherapy. Eur J Cancer 41:727–734

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Neurosurgery, Children’s Memorial Hospital, Chicago, IL, USA

    Hideki Ogiwara, Arthur J. Dipatri Jr, Robin M. Bowman, Tadanori Tomita & Tord D. Alden

  2. 2300 children’s plaza, Chicago, IL, 60614, USA

    Tord D. Alden

Authors
  1. Hideki Ogiwara
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Arthur J. Dipatri Jr
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Robin M. Bowman
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tadanori Tomita
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tord D. Alden
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tord D. Alden.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ogiwara, H., Dipatri, A.J., Bowman, R.M. et al. Diffuse postoperative cerebellar swelling in medulloblastoma: report of two cases. Childs Nerv Syst 27, 743–747 (2011). https://doi.org/10.1007/s00381-010-1343-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00381-010-1343-3

Keywords

Search

Navigation