Management of medulloblastoma involves:

  • Acute management of raised intrancranial pressure with steroids and ventriculo-peritoneal shunt
  • Surgical debulking of primary lesion
  • Craniospinal Irradiation with boost to posterior fossa (doses depend on standard or high risk disease)

Acute Management

Patients should be started on dexamethasone to counter cerebral oedema. An urgent ventriculo-peritoneal shunt should be placed to relieve obstructive hydrocephalus.


If possible, complete resection should be attempted - but only if safe to do so. The other main objective of surgery is to re-establish normal CSF flow from the third ventricle to the outer CSF resevoirs.


For low and intermediate risk ('standard risk') patients are treated with craniospinal irradiation (23.4 Gy) followed by a boost to the primary site in the posterior fossa (additional 32.4 Gy in 16#).
High risk patients receive 36 Gy to the craniospinal axis (20 fractions) followed by a boost to the entire posterior fossa (additional 19.8 Gy in 11#)
Radiotherapy is given concurrently with vincristine.


Adjuvant chemotherapy (PCV) is prescribed at the completion of chemoradiotherapy.