Management of Involuntary Mouth Chewing in Medulloblastoma

Diagnostic Approach

• The National Comprehensive Cancer Network recommends assessing for disease progression or leptomeningeal dissemination using MRI with gadolinium contrast of brain and spine, as this is superior to other modalities for detecting CNS involvement 1, 2, 3
• Medulloblastoma is classified as a malignant grade 4 primary CNS tumor with rapid growth and tendency to disseminate within the CNS, according to the National Comprehensive Cancer Network 4, 5, 6

Imaging and Laboratory Evaluation

• Brain and spine MRI with gadolinium contrast is the standard for assessing disease burden and detecting leptomeningeal metastases in medulloblastoma, as recommended by the National Comprehensive Cancer Network 1, 2, 3
• CSF cytology is part of standard response assessment if leptomeningeal disease is suspected and lumbar puncture is safe, according to the National Comprehensive Cancer Network 1, 2, 3

Management Based on Etiology

• If tumor progression is identified, the National Comprehensive Cancer Network strongly recommends referral to a specialized center or "center of excellence" with expertise in medulloblastoma management 4, 5, 6
• For recurrent/progressive disease, rebiopsy the tumor to distinguish between recurrent medulloblastoma and secondary malignancy, and to identify actionable molecular findings, as recommended by the National Comprehensive Cancer Network 7

Multidisciplinary Coordination

• The National Comprehensive Cancer Network recommends multidisciplinary review involving neuro-oncology, neurosurgery, radiation oncology, and neurology in treatment planning for medulloblastoma patients 4, 5, 8