Single photon emission tomography following posterior fossa surgery in patients with and without mutism

Erşahin, Yusuf; Yararbaş, Ülkem; Duman, Yusuf; Mutluer, Saffet

doi:10.1007/s00381-002-0614-z

Cited by 41 publications

(20 citation statements)

References 34 publications

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“…63 Multiple studies have supported the theory of cerebellocerebral diaschisis using different imaging techniques that revealed decreased blood flow, metabolic action, and function within supratentorial structures that play a crucial role in speech production, such as the thalami, inferior frontal gyrus, and temporal lobe. 26,34,63,65,83 In almost every case the abnormal findings returned to normal when mutism resolved.…”

Section: Pathophysiologymentioning

confidence: 93%

“…Blood flow returned to normal when mutism resolved. Later 26 Erşahin and colleagues reported on 1 patient with right cerebellar hemisphere hypoperfusion. Sagiuchi et al 83 reported a case of CM in a 4-year-old boy with atrophy of both cerebellar hemispheres, predominately the right hemisphere, on MRI and circulatory disturbance in both hemispheres secondary to tumor resection in SPECT scans.…”

Section: Pathophysiologymentioning

confidence: 99%

“…Brainstem involvement seems to be the most important, including preoperative tumor invasion or postoperative edema. 26,52,108 Moreover, McMillan et al 61 supported that brainstem compression could be used as a predictor of postoperative CM. Some authors believe that midline location predisposes to the occurrence of CM, 9,36,53,55 while others have found no significant difference.…”

Section: Risk Factorsmentioning

confidence: 99%

“…It usually appears as a consequence of posterior fossa surgery in children with cerebellar or fourth ventricle tumors. 52,82,108 Other causes that have been reported are infections, 15,19,24,26,72 posterior fossa hematomas (surgically removed 31,89 or not 60 ), arteriovenous malformations, 33,51,82 a brainstem tumor, 82 a pineal gland tumor, 23 and traumatic cerebellar injury. 15,82 Although this clinical entity is mainly seen in children, there are also reports of CM in adults.…”

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confidence: 99%

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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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Section: Pathophysiologymentioning

confidence: 93%

Section: Pathophysiologymentioning

confidence: 99%

Section: Risk Factorsmentioning

confidence: 99%

mentioning

confidence: 99%

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Cerebellar mutism

Pitsika¹,

Tsitouras²

2013

PED

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“…Single photon emission computed tomography (SPECT) revealed inconsistent fi ndings of local hypoperfusion in mute patients after posterior fossa surgery. Various MRI fi ndings were suggestive of ischemia, edema, and structural damage of midline structures as contributing factors (Pollack et al 1995 ;Ersahin et al 2002 ). Since younger children are far more prone to develop CMS after posterior fossa surgery than older children and younger age is also associated with less favorable outcome, developmental factors -such as neuronal lesion due to incompletely myelinated pathways -have been hypothesized to play a role as well (Ronning et al 2005 ).…”

Section: Posterior Fossa Syndrome/ Cerebellocerebral Diaschisismentioning

confidence: 99%

Female Pelvis: Genital Organs

Forstner

Cunha²

2015

Imaging of Complications and Toxicity Following Tumor Therapy

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Medical Radiology-Diagnostic Imaging is a unique series that aims to document the most innovative technologies in all fi elds within diagnostic imaging and interventional radiology, thereby informing the physician in practice of the latest advances in diagnostic imaging and percutaneous imageguided minimally invasive procedures. Th e contents are intended to cover all organs, and all modern imaging techniques and image-guided treatment modalities, with special emphasis on applications in clinical practice. Each volume is a comprehensive reference book on a topical theme, and the editors are always experts of high international standing. Contributions are included from both clinicians and researchers, ensuring wide appeal. Medical Radiology -Radiation Oncology is a unique series that aims to document the most innovative technologies in all fi elds within radiology, thereby informing the physician in practice of the latest advances in diagnostic and treatment techniques. Th e contents range from contemporary statements relating to management for various disease sites to explanations of the newest techniques for tumor identifi cation and of mechanisms for the enhancement of radiation eff ects, with the emphasis on maximizing cure and minimizing complications. Each volume is a comprehensive reference book on a topical theme, and the editors are always experts of high international standing. Contributions are included from both clinicians and researchers, ensuring wide appeal. This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifi cally the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfi lms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specifi c statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. AbstractA precise knowledge of antineoplastic drugs is an indispensable basis for the care of patients with cancer. The mechanisms of action and resistance, cross-resistance patterns, pharmacodynamics and pharmacokinetics, pharmacological interaction, and last but not least potential adverse effects should be part of this knowledge. As contemporary cancer care requires interdisciplinary and multiprofessional structures, the radiologist is an important a...

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The cerebellar mutism syndrome and its relation to cerebellar cognitive function and the cerebellar cognitive affective disorder

Wells

Walsh

Khademian

et al. 2008

Dev Disabil Res Revs

115

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The postoperative cerebellar mutism syndrome (CMS), consisting of diminished speech output, hypotonia, ataxia, and emotional lability, occurs after surgery in up to 25% of patients with medulloblastoma and occasionally after removal of other posterior fossa tumors. Although the mutism is transient, speech rarely normalizes and the syndrome is associated with long-term adverse neurological, cognitive, and psychological sequelae. The clinical, neuroradiographic, and neuropsychological findings associated with CMS as well as possible mechanisms of injury are reviewed. Theories about the pathophysiology of CMS have evolved along with our understanding of the cerebellum as an important structure in the distributive neurocircuitry underlying complex speech, cognition, and behavior. CMS shares many similarities with the cerebellar cognitive affective syndrome, more commonly described in adults and consisting of disturbances of executive function, visuospatial skills, nonmotor language, and affect regulation. Future directions include more thorough neuropsychological characterization, functional and diffusion tensor imaging studies, and investigations into the underlying differences that may make some patients more vulnerable to CMS.

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Single photon emission tomography following posterior fossa surgery in patients with and without mutism

Abstract: SPECT findings are not specific enough to explain how cerebellar mutism occurs. Clinical signs of brain stem involvement seem to be a significant risk factor in the development of cerebellar mutism.

Cited by 41 publications

References 34 publications

Cerebellar mutism

Cerebellar mutism

Female Pelvis: Genital Organs

The cerebellar mutism syndrome and its relation to cerebellar cognitive function and the cerebellar cognitive affective disorder

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