Delayed Occurrence of Hypertrophic Olivary Degeneration after Therapy of Posterior Fossa Tumors: A Single Institution Retrospective Analysis

(1) Background: A lesion within the dentato-rubro-olivary pathway (DROP) in the posterior fossa can cause secondary neurodegeneration of the inferior olivary nucleus: so-called hypertrophic olivary degeneration (HOD). The clinical syndrome of HOD occurs slowly over months and may be overlooked in progressive neuro-oncological diseases. Posterior fossa tumors are often located near these strategic structures. The goal of this study was to analyze the systematics of HOD occurrence in neuro-oncological patients. (2) Methods: The neuroradiological database of the university healthcare center was scanned for HOD-related terms from 2010 to 2019. After excluding patients with other causes of HOD, 12 datasets from neuro-oncological patients were analyzed under predetermined criteria. (3) Results: Patients received multimodal tumor treatments including neurosurgery, radiotherapy, and chemotherapy. HOD occurred both unilaterally (left n = 4; right n = 5) and bilaterally (n = 3). Though the mass effect of posterior fossa tumors had already affected strategic structures of the DROP, none of the patients showed signs of HOD on MRI until therapeutic measures including neurosurgery affecting the DROP were applied. HOD was visible on MRI within a median of 6 months after the neurosurgical intervention. In 67%, the presumed underlying surgical lesion in the DROP lay in the contralateral dentate nucleus. (4) Conclusion: In a selected cohort of neuro-oncological patients, therapeutic lesions within the DROP were associated with HOD occurrence.

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A Paravermal Trans-Cerebellar Approach to the Posterior Fossa Tumor Causes Hypertrophic Olivary Degeneration by Dentate Nucleus Injury

Cancers ◽

10.3390/cancers13020258 ◽

2021 ◽

Vol 13 (2) ◽

pp. 258

Author(s):

Martin A. Schaller-Paule ◽

Peter Baumgarten ◽

Volker Seifert ◽

Marlies Wagner ◽

Eike Steidl ◽

...

Keyword(s):

Brain Tumor ◽

Posterior Fossa ◽

Dentate Nucleus ◽

Clinical Syndrome ◽

Surgical Removal ◽

Posterior Fossa Surgery ◽

Tumor Surgery ◽

Cerebellar Mutism ◽

Brain Tumor Surgery ◽

Hypertrophic Olivary Degeneration

Background: In brain tumor surgery, injury to cerebellar connectivity pathways can induce a neurodegenerative disease called hypertrophic olivary degeneration (HOD), along with a disabling clinical syndrome. In children, cerebellar mutism syndrome (CMS) is another consequence of damage to cerebello–thalamo–cortical networks. The goal of this study was to compare paravermal trans-cerebellar to other more midline or lateral operative approaches in their risk of causing HOD on MR-imaging and CMS. Methods: We scanned our neurosurgical database for patients with surgical removal of pilocytic astrocytoma, ependymoma and medulloblastoma in the posterior fossa. Fifty patients with a mean age of 22.7 (±16.9) years were identified and analyzed. Results: HOD occurred in n = 10/50 (20%) patients within four months (median), always associated with contralateral dentate nucleus (DN)-lesions (p < 0.001). Patients with paravermal trans-cerebellar approach significantly more often developed HOD (7/11; 63.6%) when compared to other approaches (3/39; 7.7%; p < 0.001). Injury to the DN occurred more frequently after a paravermal approach (8/11 vs. 13/39 patients; p < 0.05). CMS was described for n = 12/50 patients (24%). Data indicated no correlation of radiological HOD and CMS development. Conclusions: A paravermal trans-cerebellar approach more likely causes HOD due to DN-injury when compared to more midline or lateral approaches. HOD is a radiological indicator for surgical disruption of cerebellar pathways involving the DN. Neurosurgeons should consider trajectories and approaches in the planning of posterior fossa surgery that spare the DN, whenever feasible.

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Persistent hydrocephalus after early surgical management of posterior fossa tumors in children: is routine preoperative endoscopic third ventriculostomy justified?

Yearbook of Neurology and Neurosurgery ◽

10.1016/s0513-5117(08)70146-7 ◽

2007 ◽

Vol 2007 ◽

pp. 213-214

Author(s):

M.R. Proctor

Keyword(s):

Posterior Fossa ◽

Surgical Management ◽

Endoscopic Third Ventriculostomy ◽

Third Ventriculostomy ◽

Posterior Fossa Tumors ◽

Persistent Hydrocephalus

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The assessment of executive functioning in pediatric patients with posterior fossa tumors: A recommendation to combine caregiver-based ratings and performance-based tests

Developmental Neurorehabilitation ◽

10.1080/17518423.2021.1915404 ◽

2021 ◽

pp. 1-10

Author(s):

Hoffmann-Lamplmair Doris ◽

Ritter Irene ◽

Leiss Ulrike ◽

Slavc Irene ◽

Pletschko Thomas

Keyword(s):

Executive Functioning ◽

Posterior Fossa ◽

Pediatric Patients ◽

Posterior Fossa Tumors ◽

And Performance

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Shunt Metastases in Posterior Fossa Tumors

Neuropediatrics ◽

10.1055/s-0028-1085332 ◽

1979 ◽

Vol 10 (03) ◽

pp. 296-300 ◽

Cited By ~ 10

Author(s):

Rainer Oberbauer ◽

Hans Tritthart ◽

Peter Ascher ◽

Gerhard Walter ◽

H. Becker

Keyword(s):

Posterior Fossa ◽

Posterior Fossa Tumors

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Hydrocephalus Associated with Posterior Fossa Tumors: How to Manage Effectively?

Neurology India ◽

10.4103/0028-3886.332260 ◽

2021 ◽

Vol 69 (8) ◽

pp. 342

Author(s):

Natarajan Muthukumar

Keyword(s):

Posterior Fossa ◽

Posterior Fossa Tumors

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PAEDIATRIC POSTERIOR FOSSA TUMORS : AN EPIDEMIOLOGICAL AND ANALYTICAL STUDY AT TERTIARY CARE CENTRE IN EASTERN INDIA

10.36106/ijar/6409694 ◽

2021 ◽

pp. 54-56

Author(s):

S. I. Sadique ◽

Md. Shahid Alam ◽

S. Chatterjee ◽

S. Ghosh

Keyword(s):

Early Diagnosis ◽

Posterior Fossa ◽

Tertiary Care ◽

Male Dominance ◽

Morbidity And Mortality ◽

Posterior Fossa Tumors ◽

Tertiary Care Centre ◽

Therapeutic Modalities ◽

Common Location ◽

Group 5

Introduction: Posterior fossa is the commonest site of primary intracranial tumors in children, accounting for 45-60% of 1 all pediatric tumors . The aims and objectives of the study is to analyse the incidence, clinical features, surgical outcome and complications in paediatric patients with posterior fossa tumor. Material and Methods: The present study is a non-randomized prospective observational study, conducted in the department of neurosurgery, Bangur Institute of Neurosciences (B.I.N), IPGME & R, Kolkata from January 2019 to December 2020. Sample size is 50. Observations & Results: Out of 480 cases of total CNS tumors who presented in the study period, 96 cases(20%) were of paediatric posterior fossa tumors. Male dominance was seen i.e. 32 cases(64%). Most of them were in the age group 5-12 years i.e. 30 cases(60%). Headache and vomiting was the most common presenting complain present in 41 cases(82%). Fourth Ventricle was the most common location, 30 cases(60%) with Medulloblastoma being the most common tumor, 24 cases(48%). Brainstem involvement was seen in 22 cases(44%). Post-op hydrocephalus and cerebellar mutism were seen in 6 cases(12%) each. Overall mortality was 8%(4 cases). Conclusion: Posterior fossa tumors are critical brain lesions with signicant neurological morbidity and mortality. Early diagnosis of posterior fossa tumors is vital to prevent potential risks of Brain stem compression, herniation, hydrocephalus and death. With rapid advancement in radiology and the advent of modern therapeutic modalities, early diagnosis and treatment reduced the morbidity and mortality rate and improved prognosis among the patients.

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