Initial Management at Presentation
- Timing of surgery: Steroids are started immediately to alleviate symptoms once a fourth ventricular tumor is identified. Surgery is performed as soon as possible once all necessary preoperative imaging and laboratory studies have been performed.
- Total or near-total resection: The surgical goal is to remove all of the tumor so as to render the child an average-risk patient with regard to adjuvant treatment planning. No more than 1.5 cm2 of tumor as seen on postoperative imaging should be left.
- Radiation: All children older than 3 years of age receive radiation to the tumor site and cranial spinal axis. Those younger than 3 years of age typically are managed with chemotherapy until they reach the age of 3 years, at which time radiation will be considered.
- Chemotherapy: Chemotherapy is also used to manage children with medulloblastomas after tumor resection.
- Multidisciplinary team management: Given the multimodality treatment for these tumors, the follow-up is typically managed in a multidisciplinary setting with periodic presentation of the case to the institutional tumor board.
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