Posterior fossa syndrome: Review of the behavioral and emotional aspects in pediatric cancer patients

Abstract

Medulloblastoma, the most common malignant brain tumor of childhood, occurs in the posterior fossa, the part of the intracranial cavity that contains the brainstem and the cerebellum. The cerebellum is involved in many complex aspects of human behavior and function, and when it is disrupted or insulted, this can lead to significant sequelae in children with posterior fossa tumors. A constellation of impairing and distressing symptoms, including mutism, ataxia/hypotonia, and emotional lability, develops in approximately 25% of children after the surgical resection of posterior fossa tumors. These symptoms may impede treatment and frequently require intervention in order for children to be able to participate in their care. The eventual recovery of speech occurs for most, but with slowly improving dysarthria over many months. Behavioral changes and emotional lability also occur. This phenomenon has been classified differently by different investigators over the past 35 years. For the purposes of this article, the term posterior fossa syndrome is used to refer to the neuropsychiatric and behavioral features that compose this condition. The current review summarizes the development of the clinical understanding of this phenomenon with a focus on near- and long-term psychosocial and psychiatric implications. Also, clinical examples of the presentation, management, and lasting implications of this syndrome are provided. This review is intended to be a resource for clinicians who treat affected children. Cancer 2017;123:551-559. © 2016 American Cancer Society.

The Financial Burden Associated with Medical Costs among Childhood Cancer Patients and Their Families Related to Their Socioeconomic Status: The Perspective of National Health Insurance Service

“…Studies on the financial burden of cancer patients were conducted for years, yet few studies on the financial burden of childhood cancer patients and their families were conducted. Childhood cancer patients require long term follow-up care and support to adjust in society after they spent most of their time at the hospital [ 37 , 38 , 43 , 44 ]. They have higher risks of developing second cancer and complications [ 44 , 45 , 46 , 47 ].…”

“…Childhood cancer patients require long term follow-up care and support to adjust in society after they spent most of their time at the hospital [ 37 , 38 , 43 , 44 ]. They have higher risks of developing second cancer and complications [ 44 , 45 , 46 , 47 ]. All those factors led to expensive medical costs [ 14 , 24 , 28 , 29 , 38 ].…”

Psychological Problems in Boys with Acute Myeloid Leukemia (AML) with Central Nervous System (CNS) Involvement; A Descriptive Study

“…Other studies have found that the destruction of emotions is associated with suppression or decreased levels of cortisol as an emotion-regulating hormone. Chemotherapy is a factor that plays a role in lowering cortisol levels (22). Other studies have found that behavioral perturbation syndrome can be used as a predictor for the physical deterioration of children with leukemia.…”

A systematic review of factors related to children's quality of life and mental health after brain tumor

“…Much of the research on morbidity after pediatric brain tumor has focused on neurocognitive, behavioral, academic, and adaptive functioning . Research indicates that particular tumors such as those in the infratentorial or posterior fossa region (eg, medulloblastoma and brain stem gliomas) are associated with poorer functional outcomes . This may be partly due to the intensive and protracted treatments children with these tumors receive.…”