Medulloblastoma Management Outcomes: A Multicenter Retrospective Cohort Study from Ethiopia (2018–2025) showing improved early survival despite persistent late decline

Abstract Purpose : Medulloblastoma is a highly malignant primary central nervous system tumor and the most common solid brain tumor in children, contributing substantially to childhood cancer mortality. Due to the lack of adequate local evidence, assessing surgical outcomes is important to guide clinical practice in Ethiopia. Methodology : A multicenter retrospective cohort study was conducted on 47 patients with medulloblastoma who underwent operative management from May 1, 2018 to September 30, 2025. Descriptive statistics were used to summarize patient characteristics, while Kaplan–Meier survival analysis and Cox proportional hazards models were applied to assess progression-free and overall survival and to identify factors associated with poor surgical and functional outcomes. Statistical significance was set at a p-value < 0.05. Result : The survival declined markedly, being alive, 37 (78.7%), 95% CI (65.5–88.5) at 1 month, decreasing to 36 (76.6%), 95% CI (63.2–86.9) at 6 months, then 22 (46.8%), 95% CI (33.1–60.9) at 1 year, further to 11 (23.4%), 95% CI (13.1–36.8) at 2 years, and only 2 (4.3%), 95% CI (0.9–13.0) remaining alive at 3 years following surgery. No patient survived at 4 years follow up. These results represent an improvement in early survival compared to our previous local research, despite a persistent decline during long-term follow-up. The analysis indicates that more complete intraoperative resection is associated with better overall survival and longer progression-free survival. The patients with brainstem compression (AOR = 52.544; 95% CI: 1.754–1574.066) and immediate postoperative complications (AOR = 93.887; 95% CI: 1.985–4440.072), delayed initiation of radiotherapy and younger age were significantly associated with poor functional outcomes in medulloblastoma patients. Conclusion: Survival outcomes for medulloblastoma patients in Ethiopia showed early improvement in survival compared to historical local data, despite a progressive decline during long-term follow-up. Gross total tumor resection and older age at diagnosis are robust independent predictors of favorable survival. Conversely, preoperative brainstem compression, immediate postoperative complications, and delayed initiation of adjuvant oncologic therapy strongly predict poor functional and survival outcomes. Optimizing surgical strategies and minimizing systemic delays in postoperative care are critical to sustaining these survival gains.