Children and adolescents with medulloblastoma frequently suffer from neuroophthalmological sequelae, according to research presented in a poster at the Society for Neuro-Oncology 27th Annual Meeting.
Researchers conducted a retrospective analysis of pediatric and adolescent patients with medulloblastoma treated at a single center from January 2012 to August 2021. The patients’ last ophthalmic assessment was used for the analysis.
A total of 56 patients (34 male and 22 female) were included in the study. The mean age at diagnosis was 7.2 years (range, 0-19). The most common molecular subtype was non-WNT/non-SHH (71.4%), followed by SHH-activated (16.1%), WNT-activated (8.9%), and nonspecified (3.6%).
The median follow-up to last ophthalmological assessment was 19.7 months (range, 0.1-93.2). Among children who underwent tumor resection at the study center (60.7%), tumors were located in the vermis (55.9%), floor of the fourth ventricle (26.5%), cerebellar hemispheres (11.8%), and lateral recess (5.9%).
Among 51 evaluable patients, 92.2% had symptoms of elevated intracranial pressure, 76.5% had ataxia, and 21.6% had visual disturbances. Of 54 evaluable patients, 11.1% had postoperative posterior fossa syndrome.
Chemotherapy was part of initial treatment in 98.2% of patients, and 23.2% had intraventricular chemotherapy. All patients older than 4 years of age received postoperative radiation to the posterior fossa (85.7%). At the last follow-up visit, 37.5% of patients had a relapse after primary treatment.
At the final assessment, common neuroophthalmological abnormalities included oculomotor disturbance (75%), esotropia (35.7%) including abducens palsy (12.5%), other cranial nerve palsies (21.4%), horizontal gaze-evoked nystagmus (51.8%), spontaneous nystagmus (16.1%), ocular tilt reaction (21.4%), and optic disc abnormalities (14.3%).
The researchers reported maintenance of good visual acuity (≥20/25) in 62.5% of patients. However, 7.1% of patients had optic pathway lesions. This included 1 patient with optic nerve metastasis and 1 with leptomeningeal carcinomatosis. The team found that 14.3% of patients required orthoptic treatment with prisms, and 5.4% of patients underwent strabismus surgery.
“Three-quarters of all children with MB [medulloblastoma] suffer from neuroophthalmological late effects,” the researchers concluded. “Regular monitoring is warranted to initiate appropriate management such as orthoptic or surgical correction of strabismus.”
Disclosures: The study authors did not provide disclosures.
Aliotti Lippolis M, Koinig S, Azizi A, Dorfer C, Pemp B. Neuro-ophthalmological findings in children and adolescents with medulloblastoma – a retrospective analysis. Presented at SNO 2022; November 16-20, 2022. Abstract NCMP-10.