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Brainstem compression: a predictor of postoperative cerebellar mutism.

H J McMillan1, D L Keene, M A Matzinger

  • 1Division of Neurology, Children's Hospital of Eastern Ontario, ON, Canada.

Child'S Nervous System : Chns : Official Journal of the International Society for Pediatric Neurosurgery
|December 17, 2008
PubMed
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Brainstem compression before surgery may predict cerebellar mutism after posterior fossa tumor resection. This compression, evident on MRI, suggests white matter injury is a key factor in developing mutism.

Area of Science:

  • Neurology
  • Neurosurgery
  • Pediatric Oncology

Background:

  • Cerebellar mutism is a frequent complication following posterior fossa tumor resection in children.
  • Preoperative magnetic resonance imaging (MRI) revealed significant brainstem compression in patients who later developed mutism.

Purpose of the Study:

  • To investigate the association between preoperative brainstem compression and the development of postoperative cerebellar mutism.
  • To determine if the degree of pons compression correlates with the incidence or severity of mutism.

Main Methods:

  • Retrospective review of patients aged 18 months to 18 years who underwent resection of a midline, posterior fossa tumor.
  • Analysis of demographic data, tumor pathology, mutism characteristics, and complications from hospital records.

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  • Assessment of tumor size and pons compression severity using pre- and postoperative MRI scans.

    • Main Results:

    • Patients who developed mutism exhibited greater preoperative pons compression compared to those who did not.
    • A more significant increase in pons diameter was observed postoperatively in patients with mutism.

    Conclusions:

    • Preoperative brainstem compression is a significant predictor of postoperative cerebellar mutism.
    • Mutism may result from white matter injury, including surgical manipulation, traction, and axonal damage due to the release of compressive forces.
    • Disrupted axon integrity and function due to mechanical forces are likely underlying mechanisms of mutism.