Professor Jing Junjie: Can You Take a Shower After Surgery for Medulloblastoma? Can You Fly?

Source: Sunflower Children  

Author: Sunflower Children  

Editor: Gao ZX  

Date: December 7, 2023  

The "Medulloblastoma Q&A" column invites experts in the field of pediatric brain tumors to address various questions related to medulloblastoma.

Today, we bring you the 9th issue, and we welcome everyone to leave your questions in the comments!

1. Can a recurrent medulloblastoma be treated with surgery again?

The surgical treatment of recurrent medulloblastoma needs to consider the time of recurrence, the site of recurrence, and the pattern of recurrence. Generally, when a recurrence is identified, the first step is to clarify the pathological nature of the recurrent lesion. If the tumor can be surgically removed, it should be done to reduce the tumor burden and create space for subsequent treatment.

In cases of local recurrence without metastatic lesions, the first consideration should be the removal of the lesion, followed by additional treatment based on the molecular pathological characteristics of the lesion. If there is an isolated recurrence at a distant site, surgical removal should also be prioritized before further treatment.

If the recurrence is widely metastatic, especially with dissemination in the cerebrospinal fluid system and lesions that cannot be surgically removed, less invasive methods (such as cerebrospinal fluid biopsy or stereotactic brain biopsy) can be used to obtain pathology to guide comprehensive treatment. After treatment, further evaluation can determine if there is an opportunity for surgery.

It is particularly important to note that when medulloblastoma recurs after a long period of control (3-5 years), the possibility of a second tumor must be considered. In such cases, surgical resection or biopsy is necessary to differentiate between recurrence and the formation of a new tumor.

2. Will there be a recurrence after surgery?

Medulloblastoma is the most common type of malignant tumor in children's brains and is highly malignant. Currently, the treatment involves surgery followed by radiation therapy and chemotherapy based on the patient's tumor's genetic classification and dissemination risk stratification. In recent years, treatment outcomes have significantly improved; according to current reports, the five-year survival rate for medulloblastoma patients can reach 70% to 80%, meaning that 20% to 30% of patients do not survive beyond five years. The cause of death for these patients is usually tumor recurrence, as tumors often respond poorly to radiation and chemotherapy, leading to inadequate control.

As for how soon after surgery medulloblastoma might recur, there is no definitive conclusion in the literature, as statistical benchmarks are usually set at every five years. Based on clinical experience, recurrence generally occurs more easily within two to three years post-surgery; however, cases of recurrence shortly after surgery or even five to ten years later have also been reported.

Thus, the timing of recurrence after medulloblastoma surgery varies from patient to patient. For highly malignant tumors, parents should remain vigilant after treatment ends, regularly check in for follow-ups, and maintain consistent communication with the treating physician to dynamically monitor the patient's condition, ensuring early detection and treatment if recurrence occurs.

3. How soon after surgery should follow-up treatment begin for medulloblastoma?

Comprehensive treatment for medulloblastoma includes surgery followed by radiation therapy and chemotherapy. Ideally, children should start follow-up treatment one month after surgery. This can involve either radiation therapy or chemotherapy. The decision on whether to begin with radiation or chemotherapy depends on specific circumstances.

For example, if a child is very young and has not reached the minimum age for radiation therapy, or if the child has already shown signs of tumor dissemination, or is uncooperative during the procedure, it is common to administer one to two cycles of chemotherapy first. Once the child's condition improves and they can cooperate with radiation therapy, radiation will be initiated. For older children without tumor dissemination and with clean surgical margins, radiation therapy is usually recommended first.

In summary, postoperative radiation and chemotherapy are essential stages of treatment for medulloblastoma patients, and individualized treatment plans should be developed based on the specific circumstances of each patient.

4. Can you take a shower after surgery for medulloblastoma?

After a craniotomy for medulloblastoma, the incision typically takes about two weeks to heal. It is not recommended to take a shower before the incision has healed to avoid contamination; sponge baths are a suitable alternative. Two weeks post-surgery, if the wound has healed well and the stitches have been removed, you can gradually begin to take showers, but care must be taken to protect the incision site and avoid scratching. Generally, after one month, normal showering can resume. Additionally, during the postoperative period, especially during radiation and chemotherapy, a child's immune system might be compromised, making them more susceptible to colds and pneumonia, so it is important to ensure they stay warm while bathing.

5. Can you fly after surgery for medulloblastoma?

If a child recovers well after surgery for medulloblastoma, flying generally should not be an issue.

Some patients may have implanted devices such as shunts, infusion pumps, or titanium plates, which do not affect their ability to fly. If there are issues at security checkpoints, a letter from the hospital can be provided.

In rare cases where there are complications such as poor wound healing, cerebrospinal fluid leaks, intracranial air accumulation, or conditions like hydrocephalus, elevated intracranial pressure, uncontrolled intracranial infections, or seizures, caution is advised when flying. If such situations arise, it is generally recommended to wait until the patient is stable before leaving the hospital; if travel is necessary, alternatives like train or car travel should be considered to avoid flying.

Layout | Ling Xiao  

Proofreading | Chen Zhenyu