In Reply We completely agree that the standard initial step of treatment of adult medulloblastoma is maximal safe resection as outlined in the National Comprehensive Cancer Network guidelines. However, in the event that this resection is not possible, radiotherapy and postradiation chemotherapy are recommended. The professional opinion of the neurosurgeons treating the patient presented in the article1 was that surgical resection for the ill-defined lesion would be difficult and could result in neurologic sequelae that would be unacceptable for the patient. After that decision was made, the clinical course of action was radiotherapy followed by chemotherapy and close follow-up. We were not involved in the clinical decision making for this patient’s case. About 2 years after diagnosis, serial monitoring by magnetic resonance imaging discovered a more discrete enhancing nodule near the initial biopsy site. This nodule was completely resected and the patient is doing well.
Battiste J, Shu F, Vernino S. Medulloblastoma and Dizziness—Reply. JAMA Neurol. 2014;71(6):801-802. doi:10.1001/jamaneurol.2014.522