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Cerebellar mutism in children: report of six cases and potential mechanisms
1Division of Child Neurology, Childrens Hospital Los Angeles, CA 90027, USA.
Insights
Cerebellar mutism, a rare complication after posterior fossa surgery or trauma in children, can cause temporary speech loss. Prompt recognition and understanding of its link to cerebellar structures are crucial for patient care.
Area of Science:
- Pediatric Neurology
- Neurosurgery
- Neuroscience
Background:
- Cerebellar mutism is a rare but significant complication following posterior fossa surgery or trauma in children.
- It is often associated with posterior fossa tumors or hemorrhages.
Purpose of the Study:
- To review cases of cerebellar mutism in children to understand its incidence, causes, and clinical course.
- To identify potential etiological factors and suggest mechanisms for this neurological deficit.
Main Methods:
- Retrospective review of medical records of six children (aged 6-12 years) who developed cerebellar mutism.
- Analysis of patient history, surgical procedures, tumor types, and clinical outcomes.
Main Results:
- An incidence of 1.6% cerebellar mutism was observed after posterior fossa resection in children with primitive neuroectodermal tumors.
- Mutism occurred after surgery or trauma, with some cases coinciding with hydrocephalus.
- The duration of mutism ranged from 10 days to 8 weeks, with dysarthria noted during recovery.
Conclusions:
- Cerebellar mutism is a recognized, reversible side effect of posterior fossa surgery or trauma in children.
- Damage to the dentate nucleus or superior cerebellar peduncle is hypothesized as the cause.
- Increased awareness among clinicians is essential for timely diagnosis and management.
Abstract:
Cerebellar mutism is a rare finding associated with resection of posterior fossa tumors or cerebellar hemorrhages. We reviewed the medical records of six children, aged 6 to 12 years, who developed cerebellar mutism after resection of a posterior fossa mass or as a result of posterior fossa trauma. From 1989 to 1994, 210 children underwent posterior fossa resection at our institution, and four developed mutism (an incidence of 1.6%). All four patients had primitive neuroectodermal tumors. The fifth patient experienced trauma, and another patient had an arteriovenous malformation (AVM). In four children, hydrocephalus developed as a result of their tumor or AVM. Four developed cerebellar mutism 24 to 48 hours after surgery or trauma, and one developed cerebellar mutism 5 days after surgery, coincident with hydrocephalus. In one, mutism occurred after a second resection was performed for a recurrence of his posterior fossa tumor. Cerebellar mutism lasted 10 days in one patient and 2 to 8 weeks in the other four. Dysarthria was apparent in four patients during the recovery phase. We suggest trauma to the dentate nucleus and/or its outflow tract, the superior cerebellar peduncle, as a cause of reversible mutism. Because posterior fossa tumors are common in children, mutism should be recognized as an important side effect of surgery.