[Adult medulloblastomas: our experience]. / Meduloblastomas del adulto: serie quirúrgica de 11 casos.

INTRODUCTION: Medulloblastomas are malignant, invasive and highly cellular tumours from the cerebellum, rarely seen in adults. We describe the experience in the treatment of this entity in our institution. MATERIALS AND METHODS: A retrospective study was made including 11 adult patients with medulloblastomas confined to the craniospinal axis treated between 1984-2010. Clinical, radiological and therapeutic data were assessed during the evolution of this entity. RESULTS: Mean age of patients was 30.2 years (9 women/2 men). Over 80% of the patients presented intracranial hypertension, while 54.5% presented cerebellum syndrome. Gross total surgical resection was achieved in 8 patients (72.7%) and subtotal resection in the other 3 (27.3%). All patients received craniospinal radiotherapy. After primary surgical resection, 6 patients received chemotherapy with cisplatin (CDDP) and etoposide (VP-16). During the follow up period and after a median time of 35.2 months, 4 patients (36.4%) presented with relapse, mainly in the posterior cranial fossa, managed in the majority of cases with surgical resection plus additional chemotherapy. Mean survival time was 100.3 months with a 5- and 8- year overall survival rate of 84 and 56% respectively. CONCLUSIONS: In the treatment of this malignancy, gross surgical resection has a crucial role, followed as soon as possible by oncological therapy, specially radiotherapy if needed.

[Linear accelerator radiosurgery for the treatment of vestibular schwannoma]. / Radiocirugia con acelerador lineal en el tratamiento del schwannoma vestibular.

INTRODUCTION AND AIM: Radiosurgery is among the treatment options for patients with vestibular schwannoma. We present the experience in our institution in the treatment of this disease with this technique. PATIENTS AND METHODS: A retrospective study was made including 20 patients (11 women and 9 men; median age: 55.15 years-old) with vestibular schwannoma who received linear accelerator radiosurgery treatment since April 2005 until December 2008. Follow-up period was between 12 and 42 months, considering clinical examination of cranial nerves VII (House-Brackmann scale) and VIII (Gardner-Robertson scale) as well as radiological findings (considering tumor volume). For statistical analysis, the Fisher's exact test and logistic regression test were used. RESULTS: Certain worsening of hearing function was present in 25% of the patients. Five patients had large tumors at the moment of the treatment (equal or larger than 3.5 cm3), from which four deteriorated from headache, unsteady gait, dizziness/vertigo, facial numbness and tinnitus, with statistical significance (p < 0.05). From the first year of treatment on, there was a tumor volume decrease tendency, with no tumor growth in the medium/long term follow-up, achieving a local control rate of 100%. CONCLUSIONS: Radiosurgery has become an alternative in the treatment of patients with vestibular schwannoma of appropriate size, with high safety level, using low radiation doses, low rate of complications and good tumor control rate in the medium term follow-up.