Symptoms before and after posterior fossa surgery in pediatric patients
Susan Beckwitt Turkel1, Mark D Krieger, Sharon O'Neil
1Department of Psychiatry, University of Southern California Keck School of Medicine, Children's Hospital Los Angeles, Los Angeles, Calif., USA.
Insights
Posterior fossa syndrome (PFS) is common after pediatric cerebellar tumor surgery, causing mutism and ataxia. Symptoms often improve, but some patients experience lasting cognitive deficits.
Area of Science:
- Pediatric neurosurgery
- Neuro-oncology
- Child neurology
Background:
- Posterior fossa syndrome (PFS) frequently occurs after cerebellar tumor resection in children.
- PFS is characterized by postoperative mutism and ataxia.
- Associated persistent mood and cognitive abnormalities are also noted.
Purpose of the Study:
- To describe the natural history of pediatric posterior fossa tumors.
- To document the presentation and progression of symptoms related to PFS.
- To assess cognitive outcomes following cerebellar tumor resection.
Main Methods:
- A prospective study was conducted over two years.
- Participants included children and adolescents with cerebellar tumors identified via neuroimaging.
- Data collection involved clinical observation and neuropsychological assessment.
Main Results:
- The study included 22 pediatric patients (8 girls, 14 boys) aged 14 months to 17 years.
- All patients with midline tumors developed PFS symptoms, which began preoperatively, peaked post-surgery, and gradually improved.
- Neuropsychological testing revealed persistent cognitive deficits in 10 patients.
Conclusions:
- This study offers insights into the natural course of pediatric posterior fossa tumors and associated syndromes.
- PFS symptoms are common but often transient, though cognitive impairments may persist.
- Further research is warranted to understand and manage long-term outcomes.
Unlabelled:
The posterior fossa syndrome (PFS) is common after cerebellar tumor resection in pediatric patients. It is characterized by postoperative mutism and ataxia and associated with persistent abnormalities in mood and cognition.
Method:
A 2-year prospective study of children and adolescents with cerebellar tumors identified by neuroimaging was performed at the Children's Hospital Los Angeles.
Results:
There were 8 girls and 14 boys in the study, aged 14 months to 17 years. The tumor sizes ranged from 2 to 6.5 cm in diameter. The patients presented with ataxia, headache, vomiting, depressed or irritable mood and inattention. Symptoms of PFS were present postoperatively in all except for the 2 patients with lateral tumors. The symptoms began before resection, were most prominent immediately after surgery, and improved over time. Neuropsychological assessment of 10 patients documented a persistent cognitive decrement.
Conclusion:
This small, descriptive study provides information on the natural history of pediatric posterior fossa tumors from before surgery through the postoperative period.
