Medulloblastoma Treatment in New Jersey

THE BRAIN IS DIVIDED INTO two cerebral hemispheres and the cerebellum. The cerebellum lies inferior to the cerebral hemispheres and posterior to the connection between the brain and the spinal cord. Diseases of the cerebellum, such as medulloblastoma, can result in a loss of balance and coordination, headaches, vertigo, dizziness, changes in ability to think, visual disturbances, hearing loss, nausea and vomiting. At Centers for Neurosurgery, Spine, and Orthopedics there is a team of board-certified neurosurgeons, physicians, physiatrists, rehabilitation specialists, and physical therapists who can help diagnose and provide an extensive treatment plan tailored to treat any patient with a brain tumor including medulloblastomas.

What is Medulloblastoma?

A medulloblastoma is considered a central nervous system (CNS) tumor because it originates from embryonal neuroepithelial cells which are remaining fetal brain cells. It is a cancerous brain tumor that can rapidly spread to other parts of the CNS system such as the spinal cord. It can also metastasize to bones and the lymphatic system. CNS tumors that start in the brain are divided into classifications based on a number of factors including the location of the tumor, type of tumor, extent of its spread, the patient’s age and genetic history. How much of the tumor can be removed with surgery is also a factor. Because all medulloblastomas are malignant, grow rapidly, and spread quick, they are considered a Grade IV brain tumor.

Where do medulloblastomas Form?

Medulloblastomas form within the lower part of the brain near the base of the skull, called the cerebellum. The cerebellum controls movement, balance, and coordination. Due to the proximity of the cerebellum to the spinal cord, medulloblastomas often spread to the spinal cord at the nearest point which is where the spinal cord connects with the brain. This area is the spine is known as the medulla oblongata. As the medulloblastoma grows, it can obstruct the passage of cerebral spinal fluid out of the brain then down the spinal canal. This leads to hydrocephalus if not resolved by surgery.

Do Medulloblastomas Spread?

Medulloblastomas grow very quickly and can spread to other parts of the central nervous system via cerebrospinal fluid. In some rare cases, medulloblastomas spread beyond the central nervous system to affect the patient’s bones or lymphatic system. This is extremely rare. Most often a medulloblastoma only metastasizes to areas within the brain and spinal cord.

Symptoms of Medulloblastoma

Patients with medulloblastoma may experience a range of symptoms caused by the tumor. Symptoms vary widely depending on the location of the tumor, and its size. Below are a range of symptoms that may be experience with a medulloblastoma but could also be attributed to other causes:

Nausea and Vomiting
Headaches
Extreme Tiredness
Dizziness or Vertigo
Blurred or Double Vision
Reduced Fine Motor Skills
Unsteady Walk
Poor Coordination
Balance Issues
Spinal Pain
Weakness or Numbness in Extremities
Change in Bowel or Bladder Functions
Confusion or Disorientation
Seizures or Unconsciousness

Causes of Medulloblastoma

Cancer can be caused by any hereditary or environmental genetic changes that interrupt the normal operation of cells. Some medulloblastomas, particularly when they occur in childhood, linked to hereditary genetic changes passed down through the patient’s family. When an adult grows a medulloblastoma, most often the cause is unknown. Some studies indicate that patients with Gorlin’s syndrome, Li-Fauraumi or Turcot’s syndrome may be at greater risk for medulloblastoma.

Medulloblastoma is a rare form of cancer but in children, it is the most common malignant brain tumor. A medulloblastoma seldom occurs in adults, but if one were to form, it usually occurs between the ages of 20 and 40. In terms of gender, medulloblastomas are more common in males than in females and in individuals of white or Hispanic origin. According to the National Cancer Institute, nearly 4,000 individuals in the United States are currently living with medulloblastoma but only 350 are diagnosed each year.

Diagnosis of Medulloblastoma

Patients who experience neurologic symptoms suspicious of a brain tumor should undergo a physical examination and diagnostic procedures including an MRI of the brain. The MRI will confirm or rule out the presents of a brain tumor. A medulloblastoma is a solid tumor which would be located in the lower part of the brain, specifically in the cerebellum. In order to further specify the type of brain tumor, a biopsy of the tumor would be needed. A pathologist can then analyze the specimen to determine the exact type and grade of the tumor.

Initial Visit

Diagnosis typically begins with a visit to the patient’s primary care provider, and ENT doctor, or a neurologist, where they discuss symptoms and review the patient’s medical history, including any family history of cancer plus perform a general neurological evaluation involving checking vision, hearing, reflexes, muscle strength, and coordination.

Neurological Examination

Through a series of physical examination tests, the doctor can determine whether part of the brain or another part of the body is generating the symptoms. If the patient’s symptoms and neurological evaluation are not indicating a brain tumor, the doctor may order additional testing based on a differential diagnosis of symptoms and the examination such as a vision test, a hearing test, an evaluation by a neurologist, ENT doctor, or a spine specialist such as a neurosurgeon. If the evaluation, however, is suspicious of a brain tumor, imaging of the brain must be reviewed by a radiologist, neuroradiologist, neurosurgeon, or neurologist.

Imaging Tests

If a brain tumor needs to be either confirmed or ruled out, an MRI of the brain will need to be ordered. Since medulloblastomas typically appear as a solid mass, they can often be seen on imaging studies such as a magnetic resonance imaging (MRI), or computerized tomography (CT) scans. Medulloblastomas will often appear brighter if the patient is given IV contrast prior to the study. This helps visualize the tumor making it easier to locate. For more difficult-to-diagnose tumors, doctors may use perfusion MRIs or magnetic resonance spectroscopy, which provide more clarity and detail.

An MRI will also reveal whether the cancer has spread in the patient’s brain or into the medulla oblongata part of the spinal cord. The same imaging studies will also be used to determine whether there is cerebrospinal fluid blockage from the tumor or other stricture which will cause hydrocephalus and increased intracranial pressure. As hydrocephalus can present with similar symptoms as a brain tumor, both diagnoses can be determined with an MRI or CT of the brain.

Tissue Biopsy

Though imaging tests are essential to diagnosing the presence of a brain tumor for the 150 types of brain tumors, a biopsy is necessary to confirm the exact type of brain tumor. Based on the specific type of brain tumor, the appropriate type of chemotherapy, radiation therapy, and surgery can be determined. Some tumor types do not require all three components.

Based on the location of the tumor, either the complete extraction of the tumor or a small tissue biopsy would first be performed by a neurosurgeon. A sample of the brain tissue would then be sent to the lab for testing by a pathologist. The lab’s pathologist will analyze the sample to determine the types of cells present in the sample, which determines the type of brain tumor and the grade of the tumor. It is only at this time that the diagnosis of a medulloblastoma or other type of tumor or mass can be confirmed. Thereafter, the neuro-oncologist and neurosurgeon can plan further treatment course.

Lumbar Puncture

To test whether tumor cells have migrated into the cerebral spinal fluid, the doctor may perform a lumbar puncture, also known as a spinal tap. The goal of a spinal tap is to remove cerebrospinal fluid from the area between two lumbar vertebrae in the spine. The fluid is tested in a lab for abnormal cells that may signify the presence of cancer. Lumbar punctures are generally conducted after the tumor has been removed or pressure in the brain has been reduced.

Medulloblastoma Treatments

Prognosis and treatment for medulloblastoma depend on the location, size, and spread of the tumor as well as the age and general health of the patient. To provide the best chance for a positive outcome, it is important that patients undergo treatment as soon as prescribed by their neurosurgeon.

There are a number of treatment stages for patients diagnosed with medulloblastoma, including:

Tumor Removal and Biopsy

The first step is to remove the medulloblastoma via surgery. The tumor biopsy is often performed on the tissue removed during this procedure. Since medulloblastoma occurs in highly sensitive areas of the brain and spine, it may not be possible to remove the entire tumor without compromising the patient’s health. To ensure that all malignant cells have been removed, the surgery is typically followed by radiation or chemotherapy treatments.

Fluid Removal Surgery

Located at the base of the brain, a medulloblastoma can create pressure on the brain not only by its growth within a non-expanding skull by blocking the flow of cerebrospinal fluid out of the skull. This will cause the CSF fluid volume to increase further exerting pressure on the brain. To reduce pressure on the brain, a surgeon will install a drain or shunt to allow the fluid to flow away from the brain and be reabsorbed elsewhere in the body. This surgery is sometimes performed in conjunction with the tumor removal, in order to minimize the number of invasive procedures.

Radiation Therapy

Radiation therapy is conducted after surgery by a radiation oncologist, using high-energy radiation from proton therapy beams. The radiation is specifically targeted to destroy tumor cells while limiting the exposure to healthy tissue in the surrounding area. Depending on the location, size, and spread of the tumor, the patient may also require chemotherapy.

Chemotherapy

Chemotherapy consists of a one or more drugs specifically engineered to kill the specific type of tumor cells. It is administered intravenously and can be done after or in conjunction with radiation therapy. The timing of the chemotherapy depends on the location and severity of the tumor. In cases where high doses of chemotherapy are used, treatment may be followed by stem cell transplants to help the patient heal.

Treatment Options at Centers for Neurosurgery, Spine, & Orthopedics

At Centers for Neurosurgery, Spine, and Orthopedics, our team understands the need for prompt diagnosis and treatment of any neurological symptoms indicating a brain tumor. Treatment for a medulloblastoma cannot be postponed. A seasoned team of board-certified neurosurgeons, neurooncologists, radiation oncologists, physiatrists, rehabilitation specialists, and certified physical therapists work to ensure that patients receive comprehensive medulloblastoma treatment plans. CNSO is conveniently located throughout Northern New Jersey, with locations in Hudson, Morris, Bergen, and Essex County and the surrounding areas. Patients in New Jersey should contact CNSO to learn more about brain and spine tumor surgery including treatment for a medulloblastoma.