No special diet is beneficial.
Activity No activity restrictions are necessary. Few drugs are of benefit in this disease. Exceptions are glucocorticoids, which can aid in decreasing vasogenic edema.
Mannitol is useful in the acute setting when the physician is faced with a herniating patient. Chemotherapy is used as adjuvant therapy in some patients.
Administration of toxic compounds that affect choroid plexus papilloma radiation therapy organ systems is in the realm of the experienced oncologist. Drug Category: Glucocorticoids Reduction of vasogenic edema is the role of glucocorticoids in malignant brain tumors.
They can be very effective in medulloblastoma and can even alleviate hydrocephalus by reopening CSF pathways in the posterior fossa. Although any of several glucocorticoids can be used, dexamethasone is used most often. Equivalent doses of various glucocorticoids are 0.
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Drug Name Dexamethasone Decadron, Dexasone Description Most commonly used drug to treat vasogenic edema secondary to medulloblastoma. Promotes reduction of edema after craniotomy. Choroid plexus papilloma radiation therapy Dose Choroid plexus papilloma radiation therapy 10 mg IV q6h Pediatric Dose Administer as in adults Contraindications Documented hypersensitivity; active bacterial or fungal infection Interactions Barbiturates, ephedrine, phenytoin, and rifampin decrease effects; decreases effect of salicylates and vaccines used for immunization Pregnancy C - Safety for use during pregnancy has not been established.
Precautions Increases risk of multiple complications, including severe infections; monitor for signs of adrenal insufficiency when tapering drugâabrupt discontinuation may cause adrenal crisis; hyperglycemia, edema, osteonecrosis, myopathy, peptic ulcer disease, hypokalemia, osteoporosis, euphoria, psychosis, myasthenia gravis, growth suppression, and infections are possible complications Drug Name Methylprednisolone Solu-Medrol, Depo-Medrol Description Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing increased capillary permeability.
Precautions Hyperglycemia, edema, osteonecrosis, peptic ulcer disease, hypokalemia, osteoporosis, euphoria, psychosis, growth suppression, myopathy, and infections are choroid plexus papilloma radiation therapy complications Drug Name Prednisolone AK-Pred, Delta-Cortef, Articulose, Econopred Description Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reducing capillary permeability.
Precautions Caution in hyperthyroidism, osteoporosis, cirrhosis, nonspecific ulcerative colitis, peptic ulcer, diabetes, or myasthenia gravis Drug Name Prednisone Deltasone, Sterapred, Orasone Description May decrease inflammation by reversing increased capillary permeability and suppressing polymorphonuclear cell activity. Precautions Abrupt discontinuation may cause adrenal crisis; hyperglycemia, edema, osteonecrosis, myopathy, peptic ulcer disease, hypokalemia, osteoporosis, choroid plexus papilloma radiation therapy, psychosis, myasthenia gravis, growth suppression, and infections may occur Drug Name Hydrocortisone Solu-Cortef, Westcort Description Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing increased capillary permeability.
Precautions Caution in hyperthyroidism, osteoporosis, peptic ulcer, cirrhosis, nonspecific ulcerative colitis, diabetes, or myasthenia gravis Drug Name Cortisone acetate Cortone acetate Description Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing increased capillary permeability.
Not for long-term use. Adult Dose 1. Chemotherapy usually is administered on choroid plexus papilloma radiation therapy inpatient basis. Further Outpatient Care Imaging is the primary mode of monitoring residual disease, efficacy of continuing medical treatment, and recurrence or metastasis.
Because medulloblastoma is aggressive, frequent monitoring is essential. MRI should be repeated every 3 months the first year; every 4 months the second year; every 6 months the following 3 years; and yearly thereafter.
Radiation therapy is an outpatient procedure. Any signs of change in mental status are indications for outpatient visits, as they may herald hydrocephalus and possible recurrence. Lower cranial nerve or cerebellar signs also may signal recurrence.
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Taper steroids and monitor adverse effects. However, chemotherapy and radiation therapy may exacerbate edema and necessitate low-dose corticosteroids for a short period of time. Antiepileptic medication usually is necessary when the tumor is located in the posterior fossa. Spread of disease to the supratentorial compartment may cause seizures and indicate antiseizure medication. Transfer Transfer may be necessary for treatment at a center familiar with pediatric neurosurgery, pediatric oncology, or pediatric radiotherapy.
Complications Hydrocephalus the most common complication of medulloblastoma can cause secondary visual problems. Cerebellar dysfunction the second most common complication of the disease may lead to problems with coordination and gait.
Cranial nerve palsy from brainstem involvement can lead to difficulties with vision, speech, and swallowing. With subarachnoid spread to the spinal cord, the choroid plexus papilloma radiation therapy complications are radiculopathy and weakness.
Complications accompany the treatment of medulloblastoma. Fortunately, most of these complications are transient. The most common complication after surgery is a temporary worsening of ataxia accompanied by nystagmus.
One of the most commonly cited complications is cerebellar mutism. The anatomic site of origin is thought to be the deep choroid plexus papilloma radiation therapy nuclei.
The constellation of symptoms includes apathy, minimal-to-absent speech, emotional lability, and refusal to initiate movement. Hemiparesis can accompany mutism. Lower cranial nerves are intact, but the syndrome is accompanied by a swallowing apraxia. It becomes apparent several hours after surgery and persists for several weeks, usually resolving completely.
Other complications include a temporary Parinaud syndrome and pneumocephalus. A common complication of any surgery in the posterior fossa is aseptic meningitis. This can be alleviated with a short course of corticosteroids. Complications of radiation therapy have been discussed previously and include lowered IQ, small stature, endocrine dysfunction, behavioral abnormalities, secondary neoplasms, and radiation necrosis of the white matter.
Chemotherapy also has numerous adverse effects on multiple organ systems including renal toxicity, ototoxicity, hepatotoxicity, pulmonary fibrosis, and gastrointestinal disturbance.
Methotrexate, choroid plexus papilloma radiation therapy used in human papillomavirus infection cancer with irradiation, can cause permanent necrotizing leukoencephalopathy. Prognosis Medulloblastoma is a very aggressive tumor. Even vaccino x papilloma virus a good response to surgery and radiation, recurrence is common; most recurrences occur within 2 years after treatment.
The most common location of recurrence is at the primary tumor site in the posterior fossa. With the use of adjuvant chemotherapy, incidence of recurrence in the spinal canal and the supratentorial region seems to decrease. Bone is the most common site of systemic metastasis; regional lymph node sites follow. The Collin law was first hypothesized for Wilms tumor and has been expanded since to cover many pediatric tumors thought to be congenital in origin.
The Collin law states that, if a tumor has not recurred in a period of time equal to age of patient plus 9 months, that patient can be considered to be cured. The Collin choroid plexus papilloma radiation therapy generally holds for medulloblastoma; however, several late recurrences longer than 10 years after benzimidazole anthelmintic drugs have been reported.
Greater age at diagnosis has been associated with a better prognosis, most likely because adults more often harbor the less aggressive desmoplastic variant of medulloblastoma. Why females have a longer recurrence-free interval is not understood.
Patient Education Teach patients and families about early signs of hydrocephalus, especially if the patient has a ventricular shunt in place. Perform neuroimaging studies promptly if findings of an exhaustive gastrointestinal evaluation for vomiting are normal.
The child underwent a suboccipital craniotomy and resection of his medulloblastoma. MRI shows a heterogenous enhancing tumor located within the fourth ventricle with marked hydrocephalus. Effects of medulloblastoma resections on outcome in children: a report from the Children's Cancer Group.
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Feb ;38 2 Allen JC, Epstein F. Medulloblastoma and other primary malignant neuroectodermal tumors of the CNS. The effect of patients' age and extent of disease on prognosis.
J Neurosurg. Oct ;57 4 MOPP chemotherapy without irradiation as primary postsurgical therapy for brain tumors in infants and young children. J Neurooncol.
Bilet de iesire din spital S-a realizat ablatie macroscopica a tumorii, examenul anatomo-patologic a certificat diagnosticul de carcinom de plex-coroidian. Examenul clinic la internarea fost in limite normale, examenele de laborator fara modificari patologice, cu exceptia unei usoare anemii. S-a initiat chimioterapie cu VP16, Se externeaza cu recamandarile: va evita frigul, umezeala, contactul cu persoane bolnave; va evita imunizarile va sustine tratament cu Ederm ¼ tb, zilnic revine peste 3 saptamini Bilet iesire din spital 3.
May ;32 3 Prospective randomised trial of chemotherapy given before radiotherapy in childhood medulloblastoma. Med Pediatr Oncol. Sep ;25 3 Bailey P, Cushing H. A common type of midcerebellar glioma of childhood.
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Arch Neurol Psychiatr. Cure of recurrent medulloblastoma: the contribution of surgical resection at relapse.
Mar 15 ;79 6 Neuroradiology of pediatric posterior fossa medulloblastoma. Jul ;29 1 Conformal radiotherapy, reduced boost volume, hyperfractionated radiotherapy, and online quality control choroid plexus papilloma radiation therapy standard-risk medulloblastoma without chemotherapy: results of the French M-SFOP 98 protocol.
Nov 1 ;63 3 An operative staging system and a megavoltage radiotherapeutic technic for cerebellar medulloblastomas. Dec ;93 6 Chemotherapy for medulloblastomas and primitive neuroectodermal tumors. Neuropsychological sequelae of the treatment of children with medulloblastoma. High-dose carboplatin, thiotepa, and etoposide with autologous stem-cell rescue for patients with recurrent medulloblastoma.
Children's Cancer Group. J Clin Oncol. Jan ;16 1
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