XXXX : therapeutic management.

@entity1 @entity5 @entity281 @entity76 @entity1173
The therapeutic management of @entity76 is almost exclusively surgical. Although a few @entity1 survive for long periods without treatment, the majority die without surgery. Total excision is advised to prevent recurrence which almost always follows @entity5 . Moreover, radical excision is feasible since the cerebellum has a remarkable capacity to compensate after large amounts of tissue have been removed. Morbidity is related to damage to the deep cerebellar nuclei, infiltration of the brain stem, secondary adhesions, and @entity281 . @entity5 may not be macroscopically visible at the time of first operation which in turn emphasizes the need for a detailed radiological work-up using, in particular, the CT scan. Biopsy alone, decompression alone, and/or @entity1173 are usually followed by rapid recurrence and no more than 30% of @entity1 thus treated are recurrence-free five years after surgery. Approximately 40% of @entity1 have subtotal resections and, of these, only 35% are recurrence-free five years post-operatively. Despite the high risk of recurrence following subtotal removal, subtotal excision may still be followed by prolonged survival since two thirds of the @entity1 in the present study were still alive ten years or more after surgery. This is due in part to the unpredictable behaviour of @entity76 , a fact clearly demonstrated by serial CT studies of @entity1 with partially excised @entity5 which demonstrate that @entity5 may occasionally regress or even remain static for many years. Total removal, when possible, is the treatment of choice and was carried out in 41% of @entity1 in the present study. Ninety-five per cent of @entity1 were free of recurrence for 25 years or more following total removal. In fact, recurrence following total removal has only rarely been recorded and is more often found when the initially excised @entity5 contains atypical and/or malignant features. Still, a benign histology does not preclude recurrence even when a total macroscopic excision has been achieved. This again emphasises the unpredictable nature of these @entity5 and the need for long-term radiological follow-up. Overall, operative mortality should be around 5% and even less for unilateral, hemispheric, circumscribed, nodular @entity76 . Conversely, the operative mortality for @entity5 of the vermis may approach 30% and generally increase with each subsequent operation, being maximal in the first post-operative month. Radiotherapy does not reduce the rate of recurrence nor prolong the overall survival period to death in @entity1 with @entity5 .(ABSTRACT TRUNCATED AT 400 WORDS)
