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Published on: February 4, 2022
Correlation between pre- or postoperative MRI findings and cerebellar sequelae in patients with medulloblastomas
Alexandru Szathmari1, Philippe Thiesse, Sophie Galand-desmé
1Pediatric Neurosurgical Department, Neurological and Neurosurgical Pierre Wertheimer Hospital, Lyon, France.
Introduction:
Immediate and delayed cerebellar dysfunction may be expected after surgical resection of a medulloblastoma. We investigated whether pre-operative and delayed post-operative MRI may correlate with such sequelae.
Material And Methods:
The data of 31 patients in continuous complete remission after removal of medulloblastoma, irradiation and chemotherapy, were retrospectively reviewed. Magnetic Resonance Imaging (MRI) was analyzed for the following items: preoperative MRI (ratio of the surface of the tumor/posterior fossa, presence of ventricular dilatation or tonsilar hernia, involvement of the dentate nucleus) and delayed post-operative MRI (amount of cerebellar parenchyma removed, degree of cerebellar atrophy, presence of T1 hypointense regions in remaining cerebellar area and removal of region containing dentate nucleus). These data were correlated with immediate and long-term cerebellar syndrome and daily life repercussions.
Results:
On preoperative MRI, the ratio of the surface of the tumor/posterior fossa and the presence of tonsilar hernia were significantly correlated with long-term sequelae on speech (respectively P = 0.027 and P = 0.05). Initial supratentorial ventricular dilatation was correlated with ability to sustain adequately daily tasks (P = 0.002). On delayed MRI, cerebellar atrophy was inversely correlated with ability to sustain daily tasks (P = 0.002). Hypointense T1 territory in remaining cerebellar parenchyma significantly correlated with immediate post-operative cerebellar syndrome (P = 0.01) and showed a tendency for post-operative mutism (P = 0.087) but was not correlated with any long-term sequelae.
Conclusion:
Increased cranial pressure on initial MRI and cerebellar atrophy detected on subsequent MRI studies correlated with immediate and long-term cerebellar sequelae.
Insights
Preoperative MRI findings and delayed cerebellar atrophy correlate with medulloblastoma resection sequelae. These imaging markers predict both immediate and long-term neurological deficits, aiding in patient management.
Area of Science:
- Neuro-oncology
- Neuroradiology
- Neurosurgery
Background:
- Medulloblastoma resection can lead to immediate and delayed cerebellar dysfunction.
- Predictive imaging biomarkers for these sequelae are crucial for patient care.
Purpose of the Study:
- To investigate the correlation between pre-operative and delayed post-operative Magnetic Resonance Imaging (MRI) findings and cerebellar dysfunction after medulloblastoma resection.
- To identify imaging predictors of both immediate and long-term neurological deficits.
Main Methods:
- Retrospective review of 31 patients with medulloblastoma in remission.
- Analysis of pre-operative MRI (tumor/fossa ratio, ventricular dilatation, tonsilar hernia, dentate nucleus involvement) and delayed post-operative MRI (cerebellar volume loss, atrophy, T1 hypointensities, dentate nucleus removal).
- Correlation of MRI findings with immediate and long-term cerebellar syndromes and functional outcomes.
Main Results:
- Pre-operative tumor/fossa ratio and tonsilar hernia correlated with long-term speech deficits.
- Initial ventricular dilatation predicted the ability to sustain daily tasks.
- Delayed cerebellar atrophy showed an inverse correlation with sustaining daily tasks.
- T1 hypointensities on delayed MRI correlated with immediate cerebellar syndrome and showed a trend towards post-operative mutism.
Conclusions:
- Increased intracranial pressure indicated by pre-operative MRI and cerebellar atrophy on delayed MRI are associated with cerebellar sequelae.
- These imaging findings can help predict and manage neurological deficits following medulloblastoma surgery.
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