Transient mutism and speech disorders after posterior fossa surgery in children with brain tumours
A Kingma1, J J Mooij, J D Metzemaekers
1Department of Paediatric Oncology, University Hospital of Groningen, The Netherlands.
Insights
Posterior fossa tumors in children can cause speech and cognitive issues after surgery. While most children recover speech, behavioral problems may persist, highlighting the need for ongoing assessment.
Area of Science:
- Pediatric Neurology
- Neuro-oncology
- Developmental Psychology
Background:
- Posterior fossa tumors are common in pediatric oncology.
- Surgical resection is a primary treatment modality.
- Postoperative neurological deficits, including speech and cognitive impairments, can occur.
Purpose of the Study:
- To describe the postoperative neurological and neuropsychological outcomes in children with posterior fossa tumors.
- To investigate the incidence and nature of speech, cognitive, and behavioral disturbances following surgery.
- To discuss the potential pathogenesis of these deficits and the role of pre-existing deficits.
Main Methods:
- Case series presentation of four pediatric patients (aged 5-9 years) with large posterior fossa tumors (PNET, ependymoma, astrocytoma).
- Standard neuropsychological assessments, including speech evaluation, conducted pre- and post-operatively.
- Repeated neurological and neuropsychological follow-up evaluations to track recovery and persistent symptoms.
Main Results:
- All four children developed transient mutism or speech and cognitive disorders post-surgery.
- Three out of four patients achieved full speech recovery.
- The child with pre-existing neuropsychological deficits showed persistent symptoms.
- Persistent behavioral problems were observed in three out of four patients despite speech recovery.
Conclusions:
- Posterior fossa tumors in children can lead to significant postoperative speech and cognitive disturbances, sometimes termed 'cerebellar speech syndrome'.
- While speech function often recovers, persistent behavioral issues are common.
- Pre-operative neuropsychological status is a critical factor in predicting postoperative outcomes.
- Repeated neuropsychological assessments are crucial for comprehensive management and understanding of these complex pediatric neuro-oncology cases.
Abstract:
Four patients aged 5 to 9 years with large tumours located in the posterior fossa (PNET, ependymoma or astrocytoma) are presented. Patients received standard neuropsychological assessments, including speech evaluation, prior to surgery. Following tumour resection, these 4 children developed transient mutism or different types of speech and cognitive disorders, associated with behavioural disturbances. We describe course and results of repeated postoperative neurological and neuropsychological evaluations. Full recovery of speech was seen in 3 out of 4 patients; the only child with persistent symptoms was the one who already had neuropsychological deficits before surgery. However, despite fast recovery of the speech disorders more persistent behavioural problems were found in 3 out of 4 patients. Possible pathogenesis anatomical location of this "cerebellar speech syndrome" are discussed, as well as the relevance of repeated neuropsychological assessments.
