Effects of Stereotactic Lesions of the Dentate Nucleus of the Cerebellum in Man

Fraioli, Bernardo; Guidetti, Vincenzo

doi:10.1159/000102647

Cited by 49 publications

(30 citation statements)

References 6 publications

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“…The cerebellum is critical in the fluency of speech. Fraioli and Guidetti performed stereotaxic ablation on the dentate nucleus and its outflow tract, the superior cerebellar peduncle, which resulted in reversible mutism [13]. This may explain the development of mutism in patients with posterior fossa lesions.…”

Section: Discussionmentioning

confidence: 99%

Cerebellar mutism in children: Report of six cases and potential mechanisms

Koh

Turkel

Baram

1997

Pediatric Neurology

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Cerebellar mutism is a rare finding associated with resection of posterior fossa tumors or cerebellar hemorrhages. We reviewed the medical records of six children, aged 6 to 12 years, who developed cerebellar mutism after resection of a posterior fossa mass or as a result of posterior fossa trauma. From 1989 to 1994, 210 children underwent posterior fossa resection at our institution, and four developed mutism (an incidence of 1.6%). All four patients had primitive neuroectodermal tumors. The fifth patient experienced trauma, and another patient had an arteriovenous malformation (AVM). In four children, hydrocephalus developed as a result of their tumor or AVM. Four developed cerebellar mutism 24 to 48 hours after surgery or trauma, and one developed cerebellar mutism 5 days after surgery, coincident with hydrocephalus. In one, mutism occurred after a second resection was performed for a recurrence of his posterior fossa tumor. Cerebellar mutism lasted 10 days in one patient and 2 to 8 weeks in the other four. Dysarthria was apparent in four patients during the recovery phase. We suggest trauma to the dentate nucleus and/ or its outflow tract, the superior cerebellar peduncle, as a cause of reversible mutism. Because posterior fossa tumors are common in children, mutism should be recognized as an important side effect of surgery.

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Section: Discussionmentioning

confidence: 99%

Cerebellar mutism in children: Report of six cases and potential mechanisms

Koh

Turkel

Baram

1997

Pediatric Neurology

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“…45,96 In 1949 Brown included dysarthria when describing cerebellar syndrome, 69 while in 1972 Stein was the first to "incidentally" report CM. 31 In 1975 Fraioli and Guidetti 29 …”

Section: Historical Overviewmentioning

confidence: 99%

“…The dentate nucleus was the first region that was hypothesized to be involved. Fraioli and Guidetti 29 reported on 2 patients with complete absence of speech after bilateral stereotactic lesioning of the dentate nuclei. Later on many authors proposed that bilateral damage of the dentate nuclei is a critical factor for CM.…”

Section: Pathophysiologymentioning

confidence: 99%

Cerebellar mutism

Pitsika¹,

Tsitouras²

2013

PED

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Mutism of cerebellar origin is a well-described clinical entity that complicates operations for posterior fossa tumors, especially in children. This review focuses on the current understanding of principal pathophysiological aspects and risk factors, epidemiology, clinical characteristics, treatment strategies, and outcome considerations. The PubMed database was searched using the term cerebellar mutism and relevant definitions to identify publications in the English-language literature. Pertinent publications were selected from the reference lists of the previously identified articles. Over the last few years an increasing number of prospective studies and reviews have provided valuable information regarding the cerebellar mutism syndrome. Importantly, the clarification of principal terminology that surrounds the wide clinical spectrum of the syndrome results in more focused research and more effective identification of this entity. In children who undergo surgery for medulloblastoma the incidence of cerebellar mutism syndrome was reported to be 24%, and significant risk factors so far are brainstem involvement and midline location of the tumor. The dentate-thalamo-cortical tracts and lesions that affect their integrity are considered significant pathophysiological issues, especially the tract that originates in the right cerebellar hemisphere. Moderate and severe forms of the cerebellar mutism syndrome are the most frequent types during the initial presentation, and the overall neurocognitive outcome is not as favorable as thought in the earlier publications. Advanced neuroimaging techniques could contribute to identification of high-risk patients preoperatively and allow for more effective surgical planning that should focus on maximal tumor resection with minimal risk to important neural structures. Properly designed multicenter trials are needed to provide stronger evidence regarding effective prevention of cerebellar mutism and the best therapeutic approaches for such patients with a combination of pharmacological agents and multidisciplinary speech and behavior augmentation.

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“…Early studies demonstrated that stimulations or lesions of specific thalamic nuclei could alleviate dystonia in some patients [35][36][37][38]. In a few patients, surgical lesion of the dentate output nucleus of the cerebellum was also shown to alleviate dystonia [16][17][18][39][40][41][42] suggesting the involvement of this structure in the generation of some dystonia. However, a major caveat of these early surgical interventions is that the results were simply reported as case studies without the scientific rigor to allow unbiased evaluation of their efficacy.…”

Section: Clues From Surgical Interventionsmentioning

confidence: 99%

“…Another region implicated in some secondary dystonias that has received increasing attention in recent years is the cerebellum [13,14]. Historically there are numerous case reports linking cerebellar insult with dystonic symptoms [15][16][17][18] and recent studies corroborate association of dystonic symptoms with cerebellar injury [19][20][21][22].…”

mentioning

confidence: 99%