Cerebellar mutism after posterior fossa tumor resection in children: a multicenter international retrospective study to determine possible modifiable factors

2019 ◽  
Vol 36 (6) ◽  
pp. 1159-1169 ◽  
Author(s):  
Bryan Renne ◽  
Julia Radic ◽  
Deepak Agrawal ◽  
Brittany Albrecht ◽  
Christopher M. Bonfield ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Posterior Fossa ◽  
Tumor Resection ◽  
Posterior Fossa Tumor ◽  
Cerebellar Mutism ◽  
Modifiable Factors

Bromocriptine for the treatment of postoperative cerebellar mutism syndrome in pediatric patients: Three case reports

2020 ◽  
pp. 107815522098204
Author(s):  
Miguel Á Amor-García ◽  
Cecilia M Fernández-Llamazares ◽  
Silvia Manrique-Rodríguez ◽  
Álvaro Narrillos-Moraza ◽  
Marina García-Morín ◽  
...  
Keyword(s):  
Posterior Fossa ◽  
Low Dose ◽  
Pediatric Patients ◽  
Case Reports ◽  
Tumor Resection ◽  
Posterior Fossa Tumor ◽  
Cerebellar Mutism ◽  
Common Complication ◽  
Minimum Effective Dose ◽  
Biological Origin

Introduction Cerebellar mutism syndrome (CMS) is a common complication after posterior fossa tumor resection. It is characterized by a significant lack or loss of speech. Its biological origin remains unclear and there are no standardized treatments. However, bromocriptine seems to be a possible treatment for this condition. Case report In this paper, we present three cases of pediatric patients (4, 5, and 17-year old) who developed CMS after posterior fossa tumor surgery. They were treated with bromocriptine to improve neurological symptoms. Management and outcome: Bromocriptine was started at a low dose and was progressively increased to reach the minimum effective dose. After four months of treatment, a normal and fluid speech was observed in the three patients. No discontinuation due to adverse events were reported. Discussion Bromocriptine has shown to be an effective and safe treatment for CMS in pediatric patients after posterior fossa tumor resection.

Cerebellar Mutism After Posterior Fossa Tumor Resection

2014 ◽  
Vol 31 (2) ◽  
pp. 78-83 ◽  
Author(s):  
Sarah G. Ross ◽  
Lisa Northman ◽  
Marybeth Morris ◽  
Adam L. Green ◽  
Nicole J. Ullrich
Keyword(s):  
Posterior Fossa ◽  
Tumor Resection ◽  
Posterior Fossa Tumor ◽  
Cerebellar Mutism

scholarly journals “Drowning Brain in a Pool of CSF” — A Rare Complication of Periencephalic Subdural Panhygroma following Removal of a Posterior Fossa Tumor

2017 ◽  
Vol 07 (03) ◽  
pp. 223-226
Author(s):  
Bikash Behera ◽  
Ram Deo ◽  
Sanjib Mishra ◽  
Jyotirmayee Biswal ◽  
Deepak Das
Keyword(s):  
Posterior Fossa ◽  
Case Reports ◽  
Rare Complication ◽  
Tumor Resection ◽  
Foramen Magnum ◽  
Posterior Fossa Tumor ◽  
Subdural Hygroma ◽  
Posterior Fossa Tumors ◽  
Suboccipital Craniotomy ◽  
Pediatric Age Group

AbstractPosterior fossa tumors are commonly encountered in pediatric age group patients. Most of these tumors present with features of hydrocephalus in the child. Conventionally, these cases are managed by suboccipital craniotomy with decompression of the tumor mass to establish the free flow of cerebrospinal fluid (CSF) across fourth ventricle and aqueduct of Sylvius. Following resection of posterior fossa tumor, appearance of subdural hygroma is a rare phenomenon.Though few cases of subdural hygroma are reported in literature following foramen magnum decompression in Chiari's malformation, their appearance following posterior fossa tumor resection is alien to medical literature and limited to only two case reports. Here the authors present a patient with periencephalic subdural panhygroma (PSP) following posterior fossa tumor resection who was successfully treated with a ventriculoperitoneal shunt (VPS) to accomplish a symptomatic and radiologic remission.

The pathophysiology of oral pharyngeal apraxia and mutism following posterior fossa tumor resection in children

1995 ◽  
Vol 83 (3) ◽  
pp. 467-475 ◽  
Author(s):  
Andrew T. Dailey ◽  
Guy M. McKhann ◽  
Mitchel S. Berger
Keyword(s):  
Posterior Fossa ◽  
Pediatric Patients ◽  
Tumor Resection ◽  
Posterior Fossa Tumor ◽  
Posterior Fossa Tumors ◽  
Lower Cranial Nerve ◽  
Content Type ◽  
Cranial Nerve Function ◽  
Pharyngeal Musculature ◽  
Fine Print

✓ Mutism following posterior fossa tumor resection in pediatric patients has been previously recognized, although its pathophysiology remains unclear. A review of the available literature reveals 33 individuals with this condition, with only a few adults documented in the population. All of these patients had large midline posterior fossa tumors. To better understand the incidence and anatomical substrate of this syndrome, the authors reviewed a 7-year series of 110 children who underwent a posterior fossa tumor resection. During that time, nine (8.2%) of the 110 children exhibited mutism postoperatively. They ranged from 2.5 to 20 years of age (mean 8.1 years) and became mute within 12 to 48 hours of surgery. The period of mutism lasted from 1.5 to 12 weeks after onset: all children had difficulty coordinating their oral pharyngeal musculature as manifested by postoperative drooling and inability to swallow. Further analysis of these cases revealed that all children had splitting of the entire inferior vermis at surgery, as confirmed on postoperative magnetic resonance studies. Lower cranial nerve function was intact in all nine patients. Current concepts of cerebellar physiology emphasize the importance of the cerebellum in learning and language. The syndrome described resembles a loss of learned activities, or an apraxia, of the oral and pharyngeal musculature. To avoid the apraxia, therefore, the inferior vermis must be preserved. For large midline tumors that extend to the aqueduct, a combined approach through the fourth ventricle and a midvermis split may be used to avoid injuring the inferior vermis.

Long-term cognitive deficits following posterior fossa tumor resection: A neuropsychological and functional neuroimaging follow-up study.

2009 ◽  
Vol 23 (6) ◽  
pp. 694-704 ◽  
Author(s):  
Hyo Jung De Smet ◽  
Hanne Baillieux ◽  
Peggy Wackenier ◽  
Mania De Praeter ◽  
Sebastiaan Engelborghs ◽  
...  
Keyword(s):  
Posterior Fossa ◽  
Cognitive Deficits ◽  
Functional Neuroimaging ◽  
Tumor Resection ◽  
Posterior Fossa Tumor ◽  
Follow Up Study

Prone Positioning for Posterior Fossa Tumor Resection

2013 ◽  
Author(s):  
Matthias W König ◽  
Mohamed A Mahmoud ◽  
John J McAuliffe
Keyword(s):  
Brain Tumors ◽  
Prone Position ◽  
Posterior Fossa ◽  
Tumor Resection ◽  
Posterior Fossa Tumor ◽  
Physiological Changes ◽  
Prone Positioning ◽  
Posterior Fossa Tumors ◽  
Common Malignancy

Brain tumors are the second most common malignancy in children. About one third occur in toddlers under the age of 3, and about two thirds are located in the posterior fossa. Resection of posterior fossa tumors is often a lengthy procedure that is commonly performed in the prone position. The prone position is associated with physiological changes and predisposes the patient to certain types of injuries.

Postoperative facial palsy after pediatric posterior fossa tumor resection

2021 ◽  
pp. 1-6
Author(s):  
Jason K. Chu ◽  
Peter A. Chiarelli ◽  
Nolan D. Rea ◽  
Norianne Pimentel ◽  
Benjamin E. Flyer ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Posterior Fossa ◽  
Facial Palsy ◽  
Tumor Resection ◽  
Significant Risk ◽  
Posterior Fossa Tumor ◽  
Facial Weakness ◽  
Multivariate Logistic Regression ◽  
Study Results

OBJECTIVE Facial palsy can be caused by masses within the posterior fossa and is a known risk of surgery for tumor resection. Although well documented in the adult literature, postoperative facial weakness after posterior fossa tumor resection in pediatric patients has not been well studied. The objective of this work was to determine the incidence of postoperative facial palsy after tumor surgery, and to investigate clinical and radiographic risk factors. METHODS A retrospective analysis was conducted at a single large pediatric hospital. Clinical, radiographic, and histological data were examined in children who were surgically treated for posterior fossa tumors between May 1, 1994, and June 1, 2011. The incidence of postoperative facial weakness was documented. A multivariate logistic regression model was used to analyze the predictive ability of clinicoradiological variables for facial weakness. RESULTS A total of 163 patients were included in this study. The average age at surgery was 7.4 ± 4.7 years, and tumor pathologies included astrocytoma (44%), medulloblastoma (36%), and ependymoma (20%). The lesions of 27 patients (17%) were considered high grade in nature. Thirteen patients (8%) exhibited preoperative symptoms of facial palsy. The overall incidence of postoperative facial palsy was 26% (43 patients), and the incidence of new postoperative facial palsy in patients without preoperative facial weakness was 20% (30 patients). The presence of a preoperative facial palsy had a large and significant effect in univariate analysis (OR 11.82, 95% CI 3.07–45.44, p < 0.01). Multivariate logistic regression identified recurrent operation (OR 4.45, 95% CI 1.49–13.30, p = 0.01) and other preoperative cranial nerve palsy (CNP; OR 3.01, 95% CI 1.24–7.29, p = 0.02) as significant risk factors for postoperative facial weakness. CONCLUSIONS Facial palsy is a risk during surgical resection of posterior fossa brain tumors in the pediatric population. The study results suggest that the incidence of new postoperative facial palsy can be as high as 20%. The presence of preoperative facial palsy, an operation for recurrent tumor, and the presence of other preoperative CNPs were found to be significant risk factors for postoperative facial weakness.

Posterior reversible encephalopathy syndrome during posterior fossa tumor resection in a child

2010 ◽  
Vol 6 (4) ◽  
pp. 377-380 ◽  
Author(s):  
Akash J. Patel ◽  
Benjamin D. Fox ◽  
Daniel H. Fulkerson ◽  
Sasidhar Yallampalli ◽  
Anna Illner ◽  
...  
Keyword(s):  
Posterior Fossa ◽  
Posterior Reversible Encephalopathy Syndrome ◽  
Severe Hypertension ◽  
Single Case ◽  
Tumor Resection ◽  
Posterior Fossa Tumor ◽  
Lower Cranial Nerve ◽  
Posterior Reversible Encephalopathy ◽  
Cranial Nerve Dysfunction ◽  
Reversible Encephalopathy

Posterior reversible encephalopathy syndrome (PRES) has been described in the setting of malignant hypertension, renal disease, eclampsia, and immunosuppression. In addition, a single case of intraoperative (posterior fossa craniotomy) PRES has been reported; however, this case occurred in an adult. The authors present a clinically and radiographically documented case of intraoperative PRES complicating the resection of a posterior fossa tumor in a 6-year-old child. During tumor resection, untoward force was used to circumferentially dissect the tumor, and excessive manipulation of the brainstem led to severe hypertension for a 10-minute period. An immediate postoperative MR image was obtained to rule out residual tumor, but instead the image showed findings consistent with PRES. Moreover, the patient's postoperative clinical findings were consistent with PRES. Aggressive postoperative management of blood pressure and the institution of anticonvulsant therapy were undertaken. The patient made a good recovery; however, he required a temporary tracheostomy and tube feedings for prolonged lower cranial nerve dysfunction. Posterior reversible encephalopathy syndrome can occur as a result of severe hypertension during surgery, even among young children. With prompt treatment, the patient in the featured case experienced significant clinical and radiographic recovery.

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