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Risk factors for postoperative cerebellar mutism syndrome in pediatric patients: a systematic review and
Samuel D Pettersson1, Michael Kitlinski1, Grzegorz Miękisiak2
11Scientific Circle of Neurology and Neurosurgery, Neurosurgery Department, Medical University of Gdansk.
Insights
This systematic review identified key risk factors for postoperative cerebellar mutism syndrome (pCMS) in children. Brainstem invasion and medulloblastoma diagnosis significantly increase pCMS risk, while cerebellar hemisphere tumors decrease it.
Area of Science:
- Pediatric Neurosurgery
- Neuro-oncology
- Clinical Epidemiology
Background:
- Postoperative cerebellar mutism syndrome (pCMS) is a debilitating complication following pediatric neurosurgery.
- A comprehensive review of established risk factors for pCMS is currently lacking in the literature.
Purpose of the Study:
- To conduct a systematic review and meta-analysis.
- To identify and evaluate all reported risk factors for pCMS in pediatric patients.
Main Methods:
- Systematic literature search of PubMed, Embase, and Web of Science.
- Inclusion of English-language studies on pediatric patients (≤ 18 years) with comparison groups.
- Quality assessment using the Newcastle-Ottawa Scale and data pooling with RevMan 5.4.
Main Results:
- Twenty-eight studies involving 2276 patients were analyzed.
- Significant risk factors for pCMS included brainstem invasion, fourth ventricle invasion, medulloblastoma diagnosis, and vermis incision.
- Factors reducing pCMS risk were cerebellar hemisphere tumors, compression, and intraoperative imaging.
Conclusions:
- This meta-analysis provides the most extensive review of pCMS risk factors to date.
- Identified factors can aid surgeons in identifying at-risk pediatric patients for targeted interventions.
- Further research may explore the interdependencies of these identified risk factors.
Objective:
A review article assessing all the risk factors reported in the literature for postoperative cerebellar mutism syndrome (pCMS) among children remains absent. The authors sought to perform a systematic review and meta-analysis to evaluate this issue.
Methods:
PubMed, Embase, and Web of Science were queried to systematically extract potential references. The articles relating to pCMS were required to be written in the English language, involve pediatric patients (≤ 18 years of age), and provide extractable data, which included a comparison group of patients who did not develop pCMS. The quality of the included studies was evaluated using the Newcastle-Ottawa Scale. Data were pooled using RevMan 5.4, and publication bias was assessed by visual inspection for funnel plot asymmetry. The study protocol was registered through PROSPERO (ID: CRD42021256177).
Results:
Overall, 28 studies involving 2276 patients were included. Statistically significant risk factors identified from univariate analysis were brainstem invasion (OR 4.28, 95% CI 2.23-8.23; p < 0.0001), fourth ventricle invasion (OR 12.84, 95% CI 4.29-38.44; p < 0.00001), superior cerebellar peduncle invasion (OR 6.77, 95% CI 2.35-19.48; p = 0.0004), diagnosis of medulloblastoma (OR 3.26, 95% CI 1.93-5.52; p < 0.0001), medulloblastoma > 50 mm (OR 8.85, 95% CI 1.30-60.16; p = 0.03), left-handedness (OR 6.57, 95% CI 1.25-34.44; p = 0.03), and a vermis incision (OR 5.44, 95% CI 2.09-14.16; p = 0.0005). On the other hand, a tumor located in the cerebellar hemisphere (OR 0.23, 95% CI 0.06-0.92; p = 0.04), cerebellar hemisphere compression (OR 0.23, 95% CI 0.11-0.45; p < 0.0001), and intraoperative imaging (OR 0.36, 95% CI 0.18-0.72; p = 0.004) reduced the risk of pCMS.
Conclusions:
This study provides the largest and most reliable review of risk factors associated with pCMS. Although some risk factors may be dependent on one another, the data may be used by surgeons to better identify patients at risk for pCMS and for intervention planning.
