Left-handedness should not be overrated as a risk factor for postoperative speech impairment in children after posterior fossa tumour surgery: a prospective European multicentre study

Grønbæk, Jonathan Kjær; Laustsen, Aske Foldbjerg; Toescu, Sebastian; Pizer, Barry; Mallucci, Conor; Aquilina, Kristian; Molinari, Emanuela; Hjort, Magnus Aasved; Gumbeleviciene, Lingvita; Hauser, Péter; Pálmafy, Beatrix; Baarsen, Kirsten van; Hoving, Eelco W.; Zipfel, Julian; Ehrstedt, Christoffer; Grillner, Pernilla; Callesen, Michael; Frič, Radek; Wibroe, Morten; Nysom, Karsten; Schmiegelow, Kjeld; Sehested, Astrid; Mathiasen, René; Juhler, Marianne

doi:10.1007/s00381-022-05567-8

Cited by 6 publications

(3 citation statements)

References 34 publications

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“…In our case, the postoperative MRI on day 11th revealed oedema and blood in the bilateral SCP. Interestingly, studies report conflicting results on lateralized damage to the SCP and risk of CMS; however, bilateral damage to the SCP as in our case seem to increase the risk [ 49 ]. As in previously published cases, it is difficult to determine whether the injury from the initial haemorrhage, the subsequent surgical evacuation or a combination of the two caused CMS in our case.…”

Section: Discussionmentioning

confidence: 66%

Cerebellar mutism syndrome of non-tumour surgical aetiology—a case report and literature review

et al. 2023

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Cerebellar mutism syndrome (CMS) is a well-known complication of posterior fossa (PF) tumour surgery. CMS has previously been reported in cases of non-tumour surgical aetiology in a limited number of publications. We report a case of a 10-year-old girl who suffered a cerebellar haemorrhage and subsequent CMS following surgical treatment of a ruptured arteriovenous malformation (AVM) in the cerebellar vermis. The AVM was removed acutely through a transvermian access, and hydrocephalus was treated with temporary external drainage. In the postoperative period, she suffered diffuse vasospasms of the anterior cerebral circulation and had a permanent shunt placed for hydrocephalus. Her mutism resolved after 45 days but severe ataxia persisted. To our knowledge, this is the first reported case of CMS related to a vermian haemorrhagic stroke with postoperative diffuse vasospasms. Based on this case, we present a literature review on CMS of non-tumour surgical origin in children.

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Section: Discussionmentioning

confidence: 66%

Cerebellar mutism syndrome of non-tumour surgical aetiology—a case report and literature review

et al. 2023

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“…And from these, many theories to explain the postoperative paucity of speech have been postulated including: bilateral destruction or edema of the cerebellar nuclei [40], vasospasm, post-operative meningitis, unrecognized hydrocephalus, and psychiatric origin [5]. Risk factors most commonly associated with development of CMS include midline tumor location [14], surgical approach [3,25,[41][42][43][44][45][46], brain stem invasion or compression[8, 14, 47-49], tumor size [3,26,38], diagnosis of medulloblastoma [3,21,50,[50][51][52][53] and speci c tumor subtype [20,50], younger age at diagnosis [22,23] and preoperative language impairment [39], lower volume centers [22], male gender [23,54], left handedness [38,55]. Other authors failed to nd an association between age [22], ventricular size [19,22], extent of resection[8, 19,22], tumor size [22], handedness 35 , surgical approach [41], location in the cerebellar hemisphere[8], ultrasonic aspirator use [19], low volume center [19] nor second surgery [56].…”

Section: Discussionmentioning

confidence: 99%

National multicentered retrospective review of clinical and intraoperative factors associated with the development of cerebellar mutism after pediatric posterior fossa tumor resection

Kameda-Smith,

Ragulojan,

Elliott

et al. 2024

Childs Nerv Syst

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BackgroundCerebellar mutism (CM) is characterized by a signi cant loss of speech in children following posterior fossa (PF) surgery. The biological origin of CM remains unclear and is the subject of ongoing debate.Signi cant recovery from CM is less likely than previously described despite rigorous multidisciplinary neuro-rehabilitational efforts. MethodsA national multi-centered retrospective review of all children undergoing PF resection in 4 midsized Canadian academic pediatric institutions was undertaken. Patient, tumor, and surgical factors associated with the post-operative development of CM were reviewed. Retrospective identi cation of PF surgery patients including those developing and those that did not (internal control). ResultsThe study identi ed 258 patients across the 4 centers between 2010-2020 (mean age 6.73 years; 42.2 female). Overall, CM was experienced in 19.5% of patients (N = 50). Amongst children who developed CM histopathology included medulloblastoma (35.7%), pilocytic astrocytoma (32.6%), and ependymoma (17.1%). Intraoperative impression of adherence to the oor of the 4th ventricle was positive in 36.8%.Intraoperative abrupt changes in blood pressure and/or heart rate were identi ed in 19.4% and 17.8% of cases. The clinical resolution of CM was rated to be complete, signi cant resolution, slight improvement, no improvement, and deterioration in 56.0%, 8.0%, 20.0%, 14.0%, 2.0%, respectively. In the cohort of children who experienced post-operative CM as compared to their no-CM counterpart, proportionally more tumors were felt to be adherent to the oor of the 4th ventricle (56.0% vs 49.5%), intraoperative extent of resection was a GTR (74% vs 68.8%), and changes in heart rate were noted (≥ 20% from baseline) (26.0% vs 15.9%). However, a logistic regression for experiencing CM identi ed only intraoperative impression of adherence to the oor of the 4th ventricle (OR 2.32, p = 0.011), abrupt changes in intraoperative HR (> 20% from baseline) (OR 2.34, p = 0.028), and medulloblastoma histology (OR 3.77, p = 0.001) to signi cantly associated with development of post-operative CM. ConclusionAs a devastating surgical complication, identifying and understanding the biological origin of CM is the rst step to complication avoidance. Maximal safe resection irrespective of intraoperative pathology remains the strategy to minimize the devastating post-operative development of CM.

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“…However, there are studies that indicate great difficulty in identifying these risk factors and predicting with an acceptable degree of accuracy who are the patients who will develop mutism [17]. Some efforts have also been made to identify risk factors inherent to the specific cases of patients, such as motor laterality [18] and the presence of language disorders in the preoperative period, with insightful findings [19]. Among the patients described in this study, there were very different ages (from less than two years old to 15 years old).…”

Section: Discussionmentioning

confidence: 99%

Cerebellar Mutism after posterior fossa tumor surgery: is it predictable, preventable, treatable?

Jucá,

Benevides Lima,

Munhoz

et al. 2023

Arch Pediat Neurosurg

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Introduction: Posterior fossa tumors pose challenges in pediatric neurosurgery and can lead to complications such as cerebellar mutism, affecting speech and motor abilities. This study aims to describe the evolution of cerebellar mutism and identify relevant factors in its pathophysiology and prognosis. Methods: A review was conducted on three cases of children who underwent surgery for posterior fossa tumors by the same surgical team and developed postoperative cerebellar mutism. The study analyzed preoperative clinical presentation, mutism manifestation, and recovery. Additionally, a literature review was performed on the emergence, evolution, and prognosis. Results: Case 1 involved a 3-year-old girl with medulloblastoma who experienced mutism, behavioral changes, and self-mutilation after surgery. Symptoms resolved after one month but recurred with a subsequent operation, resolving again after a month. Case 2 featured a 15-year-old girl who developed severe posterior fossa syndrome, including mutism, dysarthria, aphasia, and motor impairments. With support care, she gradually improved over a year. Case 3 involved a 4-year-old boy with cerebral palsy and a posterior fossa tumor. He experienced akinetic mutism, resolved over time with rehabilitation therapies. Discussion: Cerebellar mutism following posterior fossa surgery has implications for patient recovery. It primarily involves impairment of cerebellar outflow pathways rather than direct brainstem or cortical lesions. Identifying at-risk patients remains challenging, though younger age and specific tumor characteristics may increase the likelihood of mutism. Rehabilitation, including physical and speech therapies, plays a crucial role in promoting recovery. Effective communication and support for patients and their families are essential during the recovery process.

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Left-handedness should not be overrated as a risk factor for postoperative speech impairment in children after posterior fossa tumour surgery: a prospective European multicentre study

Cited by 6 publications

References 34 publications

Cerebellar mutism syndrome of non-tumour surgical aetiology—a case report and literature review

Cerebellar mutism syndrome of non-tumour surgical aetiology—a case report and literature review

National multicentered retrospective review of clinical and intraoperative factors associated with the development of cerebellar mutism after pediatric posterior fossa tumor resection

Cerebellar Mutism after posterior fossa tumor surgery: is it predictable, preventable, treatable?

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