Transient mutism following a posterior fossa approach to cerebellar tumors in children: a critical review of the literature

Aguiar, Paulo Henrique Pires de; Plese, José Píndaro Pereira; Ciquini, Orildo; Marino, Raul

doi:10.1007/bf00301766

Cited by 73 publications

(32 citation statements)

References 17 publications

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“…This finding has been reported in several studies, either after resection of posterior fossa tumors [1][2][3][4][5][6][7][8][9][10], with arteriovenous malformation (AVM) [8,9], or with trauma [11]. It has been difficult to estimate the incidence of cerebellar mutism, and few studies have attempted to do so.…”

Section: Introductionmentioning

confidence: 72%

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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: Introductionmentioning

confidence: 72%

“…Patients with cerebellar mutism have lesions in the paramedian cerebellar vermis or floor of the fourth ventricle [1][2][3][4][5][6][7][8][9]11]. Cerebellar mutism apparently may be produced by insult to the cerebellar midline.…”

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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“…Later on many authors proposed that bilateral damage of the dentate nuclei is a critical factor for CM. 2,25,53,57,69 Asamoto et al 6 assumed that postoperative edema led to disturbance of the venous circulation, which was responsible for the dysfunction of the dentate nuclei. Dietze and Mickle 18 observed that injury to the midportion of the cerebellum caused speech disorders and if a dentate lesion coexisted, CMS was present.…”

Section: Pathophysiologymentioning

confidence: 99%

“…Ozimek et al 70 noted that a more frequent and more extensive involvement of the dentate nuclei was present in mutistic children, and evident dentate involvement was present in 73.5% of patients with CM in the study by DiRocco et al 17 The authors also noted an even higher rate of dentate nuclei involvement among children with preoperative language impairment (90% when preoperative language impairment existed vs 65.2% when it did not exist). Neuroimaging studies have shown bilateral hypodense areas at the level of the dentate nuclei 2,5 or abnormalities in T2 signal on MRI, within the dentate nuclei, mainly bilaterally. 65 However, Dailey et al 14 reported on 9 patients with CM with no edema or infarction of the dentate nucleus postoperatively; in addition, most of the children with CM were still able to perform other functions that diffuse dentate destruction or swelling would render impossible.…”

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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“…Após esta publicação, seguiram-se muitas outras abordando esse assunto [5][6][7][8][9][10][11][12][13][14][15] . Segundo estas, o mutismo que decorre de cirurgias na fossa craniana posterior apresenta algumas características peculiares, tais como maior frequência em crianças; ocorrência após ressecção de tumores cerebelares, principalmente os situados na linha média; a compreensão da palavra é sempre preservada e, finalmente, os nervos cranianos caudais apresentam função normal.…”

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Mutismo cerebelar transitório: relato de dois casos

Silva

Atayde

Brito

et al. 1999

Arq. Neuro-Psiquiatr.

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RESUMO -Relatamos dois casos de mutismo observados após ressecção de tumores do cerebelo em duas crianças do sexo feminino, tratando-se, no primeiro caso de meduloblastoma, e no segundo, de astrocitoma juvenil. Em ambas havia lesão pré-operatória de nervos bulbares. A fisiopatogenia do mutismo envolve fatores anatômicos, vasculares e emocionais. As características essenciais do mutismo cerebelar são discutidas com base em revisão da literatura.PALAVRAS-CHAVE: mutismo, afasia, tumores do cerebelo. Transitory cerebellar mutism: report of two casesABSTRACT -We present two cases of mutism observed after resection of tumors of the cerebellum, in two children of the feminine sex, being in the first case of medulloblastoma and in the second of juvenile astrocytoma. In both patients there was pre-operative lesion of low cranial nerves. The pathophysiology of the mutism involves anatomical, vascular and emotional factors, being its essential characteristics discussed with base in revision of the literature.KEY WORDS: cerebellar mutism, aphasia, cerebellar tumor.Mutismo foi definido por Crutchfield e col. 1 como uma situação na qual o paciente está consciente, mas incapaz de falar, enquanto Nagatani e col. 2 definiram-no como uma forma extrema de disartria ou anartria.Disartria provocada por disfunções cerebelares é fenômeno bastante conhecido. Charcot, em 1877 (apud Lechtenberg e Gilman 3 ) foi o primeiro autor a imputar distúrbios cerebelares como causa de disartria. Ainda segundo estes autores, Mills e Weisenburg, em 1914, introduziram a noção de que a disartria resultaria da lesão do verme cerebelar superior. Em casuística de 122 pacientes com lesões cerebelares, Lechtenberg e Gilman 3 encontraram 31 com distúrbios disártricos, mais observados em lesões acometendo a porção superior do hemisfério cerebelar esquerdo.Benson (apud Nagatani e col. 2 ), em 1979, descreveu as situações em que ocorre mutismo: lesão da área de Broca, lesão da área motora suplementar do hemisfério cerebral dominante, lesão da formação reticular mesencefálica, lesão difusa dos hemisférios cerebrais, causando paralisia pseudobulbar e talamotomia bilateral empregada no tratamento da doença de Parkinson.

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Transient mutism following a posterior fossa approach to cerebellar tumors in children: a critical review of the literature

Cited by 73 publications

References 17 publications

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

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

Cerebellar mutism

Mutismo cerebelar transitório: relato de dois casos

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