Factors Affecting White Matter Recovery After Medulloblastoma Treatment: A Six-Year TBSS Analysis

Motivation: Therapy for pediatric medulloblastoma alters white matter (WM) microstructure which is associated with neurocognitive deficits. Goal(s): This study aimed to identify significant changes in FA after therapy and to evaluate factors related to recovery over a six-year period. Approach: TBSS was used to analyze 1622 evaluations from 147 patients and 92 healthy controls. Multivariable and linear mixed models determined brain regions with microstructural changes and assessed recovery. Results: Following surgery and before radiation therapy, most areas of the brain showed lower FA values in patients. Recovery of WM integrity was typically faster in males, average-risk patients, and those diagnosed at a younger age. Impact: This study identified medulloblastoma survivors at higher risk for slower recovery of microstructural effects. These findings can be used to design targeted interventions to lessen the impact of current therapies on the developing brain.