Summary
When a malignant tumor invades the child's cerebellum, the cost of successful treatment is often significant cognitive morbidity. A review of neuropsychological outcome revealed that survivors of childhood medulloblastoma (MB) have long-term deficits in intelligence, memory, language, attention, academic skills, psychosocial function, and a compromised quality of life. These deficits varied with chronological age at tumor diagnosis and/or adjuvant treatment, type and duration of presenting symptoms, tumor extension beyond the cerebellum, a history of adjuvant radiation treatment, and time since treatment. The effects on neuropsychological outcome of other factors, such as post-surgical hydrocephalus, were less clear. To understand the interaction between two factors predictive of outcome, age at diagnosis and time since treatment, we analyzed IQ results for a new sample of 25 surgically-treated and radiated MB survivors, and found that age at diagnosis and time since treatment made separable contributions to intellectual morbidity. PIQ appeared to measure some general effects of diffuse cerebral insult because it varied with chronological age of the child at tumor diagnosis but was relatively constant in magnitude, once established. VIQ, in contrast, was somewhat less sensitive to age at diagnosis in treated MB survivors, but declined with time since treatment. These results are important for understanding the academic attainments and continuing rehabilitation needs of childhood MB survivors, because they suggest that these children progressively fail to assimilate new verbally-based knowledge at a developmentally-appropriate rate.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Rorke LB, Gilles FH, Davis RL, Becker LE: Revision of the World Health Organization classification of brain tumors for childhood brain tumors. Cancer 56: 1969–1986, 1985
Heideman RL, Packer RJ, Albright LA, Freeman CR, Rorke LB: Tumors of the central nervous system. In: Pizzo PA, Poplack DG (eds) Principles and Practice of Pediatric Oncology, 2nd ed. J.B. Lippincott Company, Philadelphia, 1993, pp 633–681
Halperin E, Kun LE, Constine LS, Tarbell NJ: Tumors of the posterior fossa of the brain and in spinal canal. In: Halperin E, Kun LE, Constine LS, Tarbell NJ (eds) Pediatric Radiation Oncology. Raven Press, New York, 1989, pp 76–107
Packer JR, Sutton LN, Atkins TE, Radcliffe J, Bunin GR, D'Angio G, Siegel KR, Schut L: A prospective study of cognitive function in children receiving whole-brain radiotherapy and chemotherapy: 2-year results. J Neurosurg 70: 707–713, 1989
Hirsch JF, Renier D, Czernichow P, Benveniste L, Pierre-Kahn A: Medulloblastoma in childhood. Survival and functional results. Acta Neurochir 48: 1–15, 1979
Mulhern R, Hancock J, Fairclough D, Kun L: Neuropsychological status of children treated for brain tumors: A critical review and integrative analysis. Med Pediatr Oncol 20: 181–191, 1992
Ris MD, Noll RB: Long-term neurobehavioral outcome in pediatric brain-tumor patients: Review and methodological critique. J Clin Exp Neuropsychol 16: 021–042, 1994
Johnson DL, McCabe MA, Nicholson HS, Joseph AL, Getson PR, Byrne J, Brasseux C, Packer RJ, Reaman G: Quality of long-term survival in young children with medulloblastoma. J Neurosurg 80: 1004–1010, 1994
Cochrane DD, Gustavsson B, Poskitt K, Steinbok P, Kestle JRW: The surgical and natural morbidity of aggressive resection for posterior fossa tumors in childhood. Pediatr Neurosurg 20: 19–29, 1994
Kao GD, Goldwein JW, Schultz DJ, Radcliffe J, Sutton L, Lange B: The impact of perioperative factors on subsequent intelligence quotient deficits in children treated for medulloblastoma/posterior fossa primitive neuroectodermal tumors. Cancer 74: 965–971, 1994
Hudson LJ, Murdoch BE: Language recovery following surgery and CNS prophylaxis for the treatment of childhood medulloblastoma: a prospective study of three cases. Aphasiology 6: 17–28, 1992
Seaver E, Geyer R, Sulzbacher S, Warner M, Batzel L, Milstein J, Berger M: Psychosocial adjustment in long-term survivors of childhood medulloblastoma and ependymoma treated with craniospinal irradiation. Pediatr Neurosurg 20: 248–253, 1994
Silverman CL, Palkes H, Talent B, Kovnar E, Clouse J, Thomas RM: Late effects of radiotherapy on patients with cerebellar medulloblastoma. Cancer 54: 825–829, 1984
Riva D, Pantaleoni C, Milani N, Belani FF: Impairment of neuropsychological functions in children with medulloblastoma and astrocytomas in the posterior fossa. Child's Nerv Syst 5: 107–110, 1989
LeBaron S, Zeltzer PM, Zeltzer LK, Scott SE, Marlin AE: Assessment of quality of survival in children with medulloblastoma and cerebellar astrocytoma. Cancer 62: 1215–1222, 1988
Peterson K, Malkin MG: Cerebellar tumors. In: Lechtenberg R (ed) Handbook of Cerebellar Diseases. Marcel Dekker, New York, 1993, pp 165–206
Becker RL, Becker AD, Sobel DF: Adult medulloblastoma: review of 13 cases with emphasis on MRI. Diagnostic Neuroradiology 37: 104–108, 1995
Park TS, Hoffman HJ, Hendrick EB, Humphreys RP, Becker LE: Medulloblastoma: clinical presentation and management. Experience at the Hospital for Sick Children, Toronto, 1950–1980. J Neurosurg 58: 543–552, 1983
Ildan F, Cetinalp E, Bagdatoglu H, Boyar B, Haclyakupoglu S, Karaday A: Cerebellar medulloblastomas in adults. Neurosurg Rev 17: 205–209, 1994
Brookshire B, Copeland DR, Moore BD, Ater J: Pretreatment neuropsychological status and associated factors in children with primary brain tumors. Neurosurgery 27: 887–891, 1990
Ellenberg L, McComb JG, Siegel SE, Stowe S: Factors affecting intellectual outcome in pediatric brain tumor patients. Neurosurgery 21: 638–644, 1987
Allen JC, Epstein F: Medulloblastoma and other primary malignant neuroectodermal tumors of the CNS. The effect of patients' age and extent of disease on prognosis. J Neurosurg 57: 446–451, 1982
Duffner PK, Cohen ME, Thomas P: Late effects of treatment on the intelligence of children with posterior fossa tumors. Cancer 51: 233–237, 1983
Kun LE, Mulhern RK, Crisco JJ: Quality of life in children treated for brain tumors. Intellectual, emotional and academic function. J Neurosurgery 58: 1–6, 1983
Silverman CL, Thomas PRM: Long-term neuropsychologic and intellectual sequelae in brain tumor patients. In: Deutsch M (ed) Management of Childhood Brain Tumors. Kluwer, Boston, 1990, pp 493–500
Chin HW, Maruyama Y: Age at treatment and long-term performance results in medulloblastoma. Cancer 53: 1952–1958, 1984
Hoppe-Hirsch E, Renier D, Lellouch-Tubiana A, Sainte-Rose C, Pierre-Kahn A, Hirsch JF: Medulloblastoma in childhood: progressive intellectual deterioration. Child's Nervous System 6: 60–65, 1990
Chapman CA, Waber DP, Bernstein JH, Pomeroy SL, LaVally B, Sallan SE, Tarbell N: Neurobehavioral and neurological outcome in long-term survivors of posterior fossa brain tumors: Role of age and perioperative factors. J Child Neurol 10: 209–212, 1995
Packer RJ, Sposto R, Atkins TE, Sutton L, Bruce DA, Siegel KR, Rorke LB, Littman PA, Schut L: Quality of life in children with primitive neuroectodermal tumors (Medulloblastoma) of the posterior fossa. Pediat Neurosci 13: 169–175, 1987
Choux M: Medulloblastomas in children. Child's Brain 9: 280–283, 1982
Aziz H: Radiation therapy of cerebellar tumors. In: Lechtenberg R (ed) Handbook of Cerebellar Diseases. Marcel Dekker, New York, 1993, pp 221–232
Packer RJ: Chemotherapy for medulloblastoma/primitive neuroectodermal tumors of the posterior fossa. Ann Neurol 28: 823–828, 1990
Raimondi AJ, Tadanori T: Hydrocephalus and infratentorial tumors. Incidence, clinical picture, and treatment. J Neurosurg 55: 174–182, 1981
Schmidt MM, Copeland D, Fletcher JM: Effects of cranial radiation therapy (CRT) and age at diagnosis (DA) on neuropsychological performance in pediatric brain tumor patients. J Clin Exp Neuropsychol 11: 30, 1989
Silber JH, Radcliffe J, Peckham V, Perilongo G, Kishnani P, Fridman M, Goldwein JW, Meadows AT. Whole-brain irradiation and decline in intelligence: The influence of dose and age on IQ score. J Clin Oncol 10: 1390–1396, 1992
Radcliffe J, Packer JR, Atkins TE, Bunin GR, Schut L, Goldwein JW, Sutton LN: Three- and four-year cognitive outcome in children with noncortical brain tumors treated with whole-brain radiotherapy. Ann Neurol 32: 551–554, 1992
Bamford FN, Morris Jones P, Pearson D, Ribeiro GG, Shalet SM, Beardwell CG: Residual disabilities in children treated for intracranial space-occupying lesions. Cancer 37: 1149–1151, 1976
Danoff BF, Cowchock S, Marquette C, Mulgrew L, Kramer S: Assessment of the long-term effects of primary radiation therapy for brain tumors in children. Cancer 49: 1580–1586, 1982
Stehbens JA, Kaleita TA, Noll RB, MacLean WE, Fr, O'Brien RT, Waskerwitz MJ, Hammond GD: CNS prophylaxis of childhood leukemia: What are the long-term neurological, neuropsychological, and behavioral effects? Neuropsychology Review Vol. 2 (2): 147–176, 1991
Cohen BH, Packer RJ, Siegel KR, Rorke LB, D'Angio GD, Sutton LN, Bruce DA, Schut L: Brain tumors in children under 2 years: Treatment, survival and long-term prognosis. Pediatr Neurosurg 19: 171–179, 1993
Moore BD, Ater JL, Copeland DR: Improved neuropsychological outcome in children with brain tumors diagnosed during infancy and treated without cranial radiation. J Child Neurol 7: 281–290, 1992
Kandel ER, Schwartz JH, Jessel TM: Principles of Neural Science. 3rd Edition. Elsevier Science Publishing Company, Inc., New York, 1991
Glickstein M: Motor skills but not cognitive tasks. Trends Neurosci 16: 450–451, 1993
Schmahmann J: An emerging concept. The cerebellar contribution to higher function. Arch Neurol 48: 1178–1187, 1991
Ivry RB, Keele SW: Timing functions of the cerebellum. J Cog Neurosc 1: 136–150, 1988
Leiner HC, Leiner AL, Dow RS: Reappraising the cerebellum: What does the hindbrain contribute to the forebrain? Behavioural Neuroscience 103: 998–1008, 1989
Leiner HC, Leiner AL, Dow RS: Cognitive and language functions of the human cerebellum. Trends Neurosci 16: 444–447, 1993
Dennis M: Language and the young damaged brain. In: Boll T, Bryant BK (eds) The Master Lecture Series: Clinical Neuropsychology and Brain Function: Research, Measurement and Practice. American Psychological Association, Washington, DC, pp 89-123
Dennis M, Barnes M: Developmental aspects of neuropsychology: Childhood. In: Zaidel E (ed) Handbook of Perception and Cognition, Volume 15: Neuropsychology. Academic Press, New York, 1994, pp 219–246
Francis DJ, Fletcher JM, Stuebing KK, Davidson KC, Thompson NM: Analysis of change: Modeling individual growth. J Con Clin Psychol 59: 27–37, 1991
Van Zomeren AH, Brouwer WH: Head injury and concepts of attention. In: Levin HS, Grafman J, Eisenberg HM (eds) Neurobehavioural Recovery from Head Injury. Oxford University Press, New York, 1987, pp 398–415
Dropcho EJ: Central nervous system injury by therapeutic irradiation. Neurologic Clinics 9: 969–988, 1991
Hoppe-Hirsch E, Brunet L, Laroussinie F, Cinalli G, Hirsch JF: Mental impairment after therapy for malignant posterior fossa tumors: an etiological study. Annales de Pediatrie 42: 482–488, 1995
Wechsler D: Wechsler Intelligence Scale for Children. The Psychological Corporation, New York, 1949
Wechsler D: Wechsler Adult Intelligence Scale. The Psychological Corporation, New York, 1955
Wechsler D: Wechsler Intelligence Scale for Children — Revised. The Psychological Corporation, New York, 1974
Wechsler D: Wechsler Adult Intelligence Scale —Revised. The Psychological Corporation, New York, 1981
Wechsler D: Wechsler Intelligence Scale for Children —Third Edition. The Psychological Corporation, New York, 1991
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Dennis, M., Spiegler, B.J., Hetherington, C.R. et al. Neuropsychological sequelae of the treatment of children with medulloblastoma. J Neuro-Oncol 29, 91–101 (1996). https://doi.org/10.1007/BF00165522
Issue Date:
DOI: https://doi.org/10.1007/BF00165522