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Cerebellar mutism: review of the literature
Thora Gudrunardottir1, Astrid Sehested, Marianne Juhler
1Department of Pediatrics, The University Hospital Rigshospitalet, 2100 Copenhagen, Denmark.
Insights
Cerebellar mutism, a complication of posterior fossa surgery in children, occurs in 11-29% of cases. This review highlights its causes, risk factors, and the need for further research into prevention and treatment.
Area of Science:
- Pediatric Neurosurgery
- Neurology
- Speech Pathology
Background:
- Cerebellar mutism (CM) is a frequent complication following posterior fossa surgery in pediatric patients.
- Understanding CM is crucial for improving surgical outcomes and patient recovery.
Purpose of the Study:
- To comprehensively review the current knowledge on cerebellar mutism.
- To examine incidence, anatomical and pathophysiological factors, risk factors, surgical considerations, treatment, prognosis, and prevention strategies.
Main Methods:
- A systematic review of peer-reviewed English publications from 1985 to 2009.
- Literature search using PubMed with keywords 'cerebellar mutism' and 'posterior fossa syndrome'.
- Cross-referencing of bibliographies to identify additional relevant studies.
Main Results:
- The incidence of postoperative cerebellar mutism ranges from 11% to 29%.
- Patients with medulloblastomas or brainstem invasion face higher risks.
- Permanent motor and non-motor speech deficits are common, particularly with right cerebellar hemisphere involvement.
- Mutism is linked to bilateral dentate nuclei perturbation; surgical techniques sparing these structures are recommended.
- Pathophysiology remains unclear, potentially involving axonal damage, edema, perfusion defects, and metabolic issues.
Conclusions:
- While incidence in medulloblastoma is documented, data for astrocytoma and ependymoma are limited.
- Further anatomical, functional imaging, and neuropsychological studies are essential for understanding CM pathophysiology and developing preventive surgical measures.
- Randomized controlled trials are needed to evaluate the efficacy of different medications and postoperative speech therapies.
Purpose:
Cerebellar mutism is a common complication of posterior fossa surgery in children. This article reviews current status with respect to incidence, anatomical substrate, pathophysiology, risk factors, surgical considerations, treatment options, prognosis and prevention.
Methods:
We reviewed all peer-reviewed English publications on cerebellar mutism between the years of 1985 and 2009. The majority were found by searching for ‘cerebellar mutism’ and ‘posterior fossa syndrome’ in PubMed. Additional cases were identified by cross-checking reference lists.
Results:
The overall incidence of postoperative cerebellar mutism is 11-29%, and patients with medulloblastomas and/or brainstem invasion are at a greater risk of developing it than those with other kinds of tumors and/or without brainstem invasion. Permanent sequelae in the form of both motor- and non-motor-related speech deficits are common, especially when the right cerebellar hemisphere is involved. The mutism is caused by bilateral pertubation of the dentate nuclei and their efferent pathways, which emphasizes the need to explore surgical methods that spare these structures. The pathophysiological mechanisms of delayed onset and resolution of cerebellar mutism are not clear, but axonal damage, edema, perfusional defects and metabolic disturbances may be involved.
Conclusion:
The incidence of cerebellar mutism is well documented in children with medulloblastoma, but precise figures for those with astrocytoma and ependymoma are lacking. Further anatomical, functional imaging and neuropsychological studies are needed to clarify the pathophysiological mechanisms in order to define preventive measures during surgery. Randomized, controlled trials of the effects of different medication and post-operative speech therapy are necessary for improving treatment.
