Cerebellar mutism following posterior fossa tumor resection in children
Kadir Kotil1, Mustafa Eras, Mustafa Akçetin
1Haseki Educational and Research Hospital, Neurosurgery Department Istanbul, Turkey. Kadirkotil@gmail.com
Insights
Cerebellar mutism, a complication of posterior fossa surgery, occurred in 32% of pediatric patients. Tumor type, midline location, and vermian incision were key risk factors, with a generally favorable prognosis.
Area of Science:
- Neurosurgery
- Pediatric Oncology
- Speech Pathology
Background:
- Cerebellar mutism is a known complication following posterior fossa surgery in children.
- Identifying risk factors is crucial for predicting and potentially preventing this condition.
Observation:
- This study analyzed 32 pediatric patients undergoing posterior fossa surgery for cerebellar tumors between 1990 and 2005.
- Systematic pre- and post-operative speech and neuroradiological assessments were performed.
Findings:
- Cerebellar mutism developed in 10 patients (32%), typically in the early postoperative period.
- Significant independent risk factors included tumor type, midline localization, and vermian incision.
- Interdependencies were noted, particularly with larger tumors (>5 cm) and medulloblastomas. Mutism onset ranged from 0-90 days (mean 15.6 days).
- Eight patients recovered normal speech, and all affected cases presented with cerebellar ataxia.
Implications:
- Posterior fossa surgery for pediatric cerebellar tumors carries a significant risk of mutism, often associated with ataxia.
- While cerebellar mutism can be concerning, it typically follows a self-limiting course with a favorable prognosis.
- Understanding these risk factors can aid in surgical planning and patient counseling.
Aim:
Cerebellar mutism is a documented complication of posterior fossa surgery in pediatric ages. Risk factors such as the type of tumor, size, and location of tumor, hyrdrocephalus, postoperative cerebellar swelling for cerebellar mutism were investigated in this study.
Material And Methods:
A consecutive series of 32 children with a cerebellar tumor were operated on at the Haseki Educational and Research Hospital, Department of Neurosurgery, between 1990 and 2005. Their speech and neuroradiological studies were systematically analysed both preoperatively and postoperatively
Results:
Cerebellar mutism developed in ten children (32%) in the early postoperative period. The type of tumor, midline localization, and vermian incision were significant single independent risk factors. In addition, an interdependency of possible risk factors (tumor > 5 cm, medulloblastoma) was found. The latency for the development of mutism ranged from 0 to 90 days (mean 15.6 d). The speech returned to normal in eight patients. All cases were accompanied by cerebellar ataxia.
Conclusion:
Mutism after posterior fossa tumor resection is also associated with ataxia. Cerebellar mutism usually has a self-limiting course and a favorable prognosis.
