Medulloblastoma is a fast-growing cancer that starts in the cerebellum, the part of the brain at the back of the head that controls balance and coordination. It is the most common malignant brain tumour of childhood, and is seen less often in teenagers and adults.
It can spread through the fluid around the brain and spine, so the whole central nervous system is assessed and treated. Treatment combines surgery, radiotherapy and chemotherapy in a specialist children's cancer centre. Outcomes vary widely with the child's age, spread and the tumour's molecular group, so only the treating team can discuss outlook.
Symptoms
- Morning headaches that improve after vomiting
- Repeated vomiting without diarrhoea
- Unsteady walking and clumsiness
- Double vision or a new squint
- Head tilt or neck stiffness
- Tiredness, irritability or a change in school performance
- A growing head size or bulging soft spot in babies
Causes and risk factors
The cause is unknown in most children and nothing the parents did or did not do is responsible. A small proportion occur in families with inherited conditions such as Gorlin syndrome, Li-Fraumeni syndrome or changes in genes such as SUFU, which is why genetic counselling is sometimes offered. Laboratory analysis now divides the tumour into four molecular groups, WNT, SHH, Group 3 and Group 4, which behave differently and influence how intensive treatment needs to be.
How it is diagnosed
- MRI of the brain and whole spine: Shows the tumour, any blockage of fluid and any spread. The spine is scanned before or soon after surgery.
- Lumbar puncture: Spinal fluid is checked for tumour cells, usually about 2 weeks after the operation.
- Histology and molecular testing: Tissue from surgery confirms the diagnosis and the molecular group.
- Baseline hearing, hormone and neuropsychology tests: Recorded before therapy because treatment can affect them.
Treatment options
- Surgery: A paediatric neurosurgeon removes as much tumour as is safely possible. A temporary drain or a procedure to relieve fluid pressure may be needed first.
- Craniospinal radiotherapy: Radiation to the brain and spine with a boost to the tumour site, usually for children over about 3 to 5 years. Proton therapy can reduce dose to healthy tissue and is often sought abroad.
- Chemotherapy: Given during and after radiotherapy, or as the main treatment in very young children to delay or avoid radiation.
- Rehabilitation: Physiotherapy, speech therapy and school support, especially after posterior fossa syndrome.
- Long-term follow-up: Surveillance scans and monitoring of growth, hormones, hearing and learning for many years.
When it is urgent
A child with worsening headache, repeated vomiting, drowsiness, a seizure or sudden loss of balance needs the nearest emergency department at once. Raised pressure in the brain is treated locally and urgently. It is never a reason to board a plane.
Travelling to Türkiye for treatment
Treatment lasts many months and should be delivered by one coordinated children's team, close to family support where possible. Travel is reasonable for a defined part of care, most often proton radiotherapy after surgery at home, or for a second opinion on pathology, molecular group and the plan. Radiotherapy should normally start within about 4 to 6 weeks of surgery, so enquiries must be made early, with scans, operation notes and pathology blocks ready. Ask who will give the chemotherapy, how the two teams will share records, and what happens if your child becomes unwell with low blood counts while away.
Send your reports, scans and a short history and a Clinic-Y coordinator replies within 24 hours with suitable teams and written, all-inclusive proposals side by side. Reviewing your case is free.
الأسئلة المتكررة
Is proton therapy better than standard radiotherapy?
Cure rates appear similar. Protons deliver less radiation to the heart, ears, hormone glands and developing brain tissue, which may reduce late effects. It matters most in younger children.
Can very young children be treated without radiotherapy?
Often yes. Infants are usually given chemotherapy-based protocols to postpone or avoid radiation to the developing brain.
What is posterior fossa syndrome?
A temporary loss of speech with unsteadiness and mood change after surgery in some children. It improves over weeks to months with therapy.
What should I send for a second opinion?
All MRI scans on disc, the operation note, the pathology report and, if possible, the tissue blocks for molecular review.