SURG-59. Peri-operative Outcomes Following Primary Surgery For Medulloblastomas And Association With Molecular Subgroups

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Abstract Medulloblastomas are most common pediatric malignant brain tumor. Molecular classification has identified 4 main subgroups (WNT, SHH, group 3 and group4) which have distinct demographic and clinical outcomes. The also have different developmental origin with distinct anatomical localization. WNT tumors commonly have epicenter around lateral brainstem, group 3/4 tumors are located in midline in the 4th ventricle and SHH are cerebellar lobar tumors. AIM: This study looks at peri-operative outcomes in patients undergoing primary surgery for medulloblastoma with respect to their molecular sub-group Method: The study is a retrospective audit of a prospectively maintained database at tertiary cancer center over period of 16 years from 2007. RESULTS 116 cases underwent primary surgery for medulloblastoma of which molecular sub-typing was available in 99 cases. Of the 99 cases, majority of cases were between 4-18 years (72%), followed by adults (15%) and 0-3 years (12%). There was a male pre-ponderance (72%:28%).61 cases were group3/4, followed by 22 SHH, and 16 WNT. Pre-operative metastasis was seen in 50.8% of group 3/4 tumors, followed by WNT (25%) and SHH (22%). Post-operative neurological worsening was seen in 36% of group3/4, followed by (18.7%) WNT and (9%) SHH group. Among variety of deficits, cerebellar mutism was most commonly seen in group 3/4 followed by SHH sub group. Post-operative meningitis rates were similar between the groups. Post-operative mortality was seen in 3% of patients in group3/4. Gross-total resection rates were highest in SHH grp (91%) followed by WNT (62.%) and group3/4(57.3%). These differences in the sub groups for various factors were not statistically significant. CONCLUSION There are differences in post-operative outcomes between various sub-groups of medulloblastomas, with post-operative deficits common in group 3/4 and highest GTR rates in SHH sub groups, probably due to different developmental and anatomical regions involved. (not statistically significant)

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