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The clinical management of pediatric medulloblastoma requires a multidisciplinary approach, which can be challenging, especially in low- and middle-income countries. The aim of this study was to identify current challenges and describe the treatment and outcomes of Iranian pediatric patients with medulloblastoma who were referred to our center in Tehran, Iran. Our retrospective review included 126 patient records from April 2007 to May 2015. The records were analyzed for epidemiologic features, treatment modalities, overall survival, and progression-free survival. Data were analyzed using SPSS 22.0 software. Median age at diagnosis was 6 years (male:female ratio, 2.3:1). At the time of diagnosis, 7 patients were 2 years or younger, and 76 (60.3%) were categorized as having high-risk disease. Overall, 100 patients had gross or near-total surgical resection. Cerebral spinal fluid involvement was detected in 22.2% of the patients tested, and spinal involvement was detected in 25% of the patients who underwent spinal MRI. Metastasis stages at the time of diagnosis were as follows: M0: 48.4% patients, M1: 16.7%, M2: 5.5%, and M3: 21.4%. Median times of follow-up and progression-free survival were 16 and 12 months, respectively. Probability of 7-year overall survival and progression-free survival were 59 and 53.8%, respectively. Results of the current retrospective study emphasize the need for implementing measures to improve outcome for our patients with medulloblastoma. Such measures include a multidisciplinary approach, unified national treatment guidelines, better disease and metastasis staging, twinning initiatives, and seeking a second opinion when needed.

Intramedullary dermoid cyst is a type of rare congenital intraspinal lesions. Its proximity and its strong adherence to the surrounding spinal cord tissue often make a complete resection of the cyst wall problematic. We retrospectively studied five cases of intramedullary dermoid cyst, focusing the recurrence of intramedullary dermoid cyst after surgery and the probable method to prevent the recurrence. Five cases of intramedullary dermoid cyst with or without other concomitant deformities were retrospectively reviewed. Subjects consisted of three males and two females, aged 2–24 years. Diagnosis was confirmed by spinal MRI and pathology studies. Surgical outcomes were analyzed. In case 2, an Ommaya reservoir was implanted in the cystic cavity, and the cystic content was sucked though the Ommaya reservoir. An 18–113 months of follow-up was conducted. The contents of intramedullary dermoid cyst were loose and easy to be cleared in the operations. The cyst wall was closely adhered to the spinal cord, and complete resection was difficult. During the follow-up of 18–113 months, the lesion reoccurred in three cases. Intramedullary dermoid cyst is prone to recurrence. The presence of residual cyst wall might be the cause of dermoid cyst recurrence. When a complete resection of cyst wall becomes infeasible, placement of an intraspinal Ommaya reservoir may help to delay and minimize clinical symptoms by aspiration of cystic contents in case of recurrence.

Dear Editor,We read with great interest the article by Yikilmaz andcolleagues, which described features of spinal magneticresonance imaging (MRI) in children with Guillain-Barresyndrome (GBS) and investigated the correlation betweenMRI characteristics and the clinical/laboratory examinations[2]. Their findings are intriguing in that MRI appearspromising as a supplementary modality to conventionaldiagnostic methods of GBS. However, we have someconcerns about this study.In this study, a control group seems missing, althoughthe authors mentioned “All patients and the control groupwere scanned with a 1.5-T clinical MR scanner” in thePatients and Methods only. As a consequence, thespecificity of contrast enhancement in spinal MRI, whichmay differentiate GBS from other diseases with/withoutnerve root involvement, is unavailable. This pitfall of thestudy design might limit the merits of their findings.Therefore, the conclusion that MRI can be used as asupplementary diagnostic modality to clinical and labora-tory findings of GBS should be further confirmed bycontrolled studies in the future.Another concern arising from the research is theenrollment of the study subjects. Since the subjects wereretrospectively selected from patients who were hospitalizedin their center with the diagnosis of GBS between 2005 and2010,weareeagertoknowhowtheauthorscouldaccumulateupto40GBScasesthatunderwentacontrast-enhancedspinalMRI. It is well established that MRI contributes to thediagnosis of GBS by demonstrating anterior and posteriorintrathechal spinal nerve roots [1]. However, the use of MRIespecially contrast-enhanced spinal MRI in GBS is currentlyuncommon. Considering the relatively low incidence of GBSin children and that this was a single-center study, we suspectthat the authors designed and conducted this investigation inaprospectiveway.References