Medulloblastoma in developmental age: Long-term neurocognitive and emotional-behavioral outcome

Hand in hand with clinical studies on patients with posterior fossa tumors, the internal architecture of the cerebellar vermis and cerebellar hemispheres have likewise been identified as well as the connectivity to specific specialized supratentorial regions of the brain within segregated circuits, the lesions of which cause specific deficits. This makes it possible to read/interpret the deficits and to link them to the specific region of the cerebellum that has been lesioned and consequently to consciously plan, when / where possible, a surgical approach that will preserve cognitive function. These variables are further complicated by the fact that a brain lesion in children in all of its complexity strikes a developing brain. The various phases of synaptogenesis, pruning, myelination and glial cell production all take place during prenatal brain growth, but they continue to develop even after birth. This inevitably alters the neurocognitive developmental trajectory by affecting the wide constellation of domains represented by intellectual, academic, neuropsychological, and psychosocial functions. Brain injury, thus, affects the patient's global course of development causing a loss of some acquired skills and altering the rate of new development. They will be discussed both biological and developmental issues that contribute to the highly variable degree of impairments occurring after medulloblastoma treatment in neurocognitive, behavioral and emotional outcome.