The thesis is devoted to the urgent problem of modern neurosurgery - improving the results of combined treatment of cerebellar medulloblastoma (MB) in children of different age groups.In our research the results of combined treatment of 297 children with MB of different age groups were analysed. Middle age of patients was (7,6±2,1) years. 33 (11,1%) patients were children of first 3 years old, 97 (32,7%) - 3-7 years, 114 (38,2%) - 7-12 years, 53 (18%) - 12-18 years. In 247 (81,3%) patients the initial place of growth of MB was a worm of cerebellum and in 34 (11,4%) - hemispheres of cerebellum. The tumor size was up to 3 cm in 52 (16,9%) patients, 3-5 cm - in 226 (76,3%), over 5 cm - in 19 (6,8%). Surgical treatment was supplemented by shunt operations in 71 (25,5%) children. Radiotherapy (RT) was conducted to 191 (71,8%) children, chemotherapy (CT) - to 128 (48,1%). During 30 days after operation died 31 (10,4%) patients. A catamnesis from 1 month up to 10 years was analysed in 266 (89,5%) children.In children of first 3 years old the Т2 and Т3а stages of MB according Chang (2002) were dominant (65,3%), in children of 3-18 years old -- Т3а and Т3в stages (70%). Т4 was in 18,1% children of 0-3 years old and in 7,5% children of 3-18 years old. A gross total resection of MB was executed in 35% patients, subtotal - in 52,8%, partial resection or biopsy - in 12,2%. Postoperative complications were in 49 (16,5%) patients. For the children of 0-3 years old anaplastic (27,3%) and "classic" forms of MB (42,4%) prevailed, which associated with the worse prognosis. For children of 3-7 years "classic" MB prevailed (65%); anaplastic MB was only at 17,5% patients. Only 3-7% of children of 7-12 years had anaplastic MB. The frequency of metastases of MB in children of 0-3 years was 18%, in patients of 3-18 years - 10-15%. Thus, the analysis of long-term results of combined treatment of MB in children of different age groups revealed that on the parameters of the median of recurrent-free survival (MRFS), quality of life, the severity of postoperative neurological symptoms and overall survival of patiens may have effect the volume of surgical resection, the presence of metastases, the histological type of tumor, the volume of further adjuvant therapy and the age of children. Thus, with only surgical treatment, MRFS in all ages did not exceed 12-18 months, with the addition of RT or CT only - 24 months and with the full implementation of protocols of combined treatment in children over than 3 years of age - 36 months and higher. In children of the first 3 years, taking into account the specifity of localization, the prevalence of "classical" and anaplastic histological types of tumors, higher risk of postoperative complications and less efficacy and the possibility of adjuvant therapy - MRFS does not exceed 18-24 months. The initial good functional state contributes to a higher quality of life of patients provided a longer MRFS. On the basis of the results of the dissertation, a diagnostic and therapeutic scheme of management of children of different age groups with MB, depending on the group of risk and age of patients, and practical recommendations were worked out.
