Injuries to inferior vermis and dentate nuclei predict poor neurological and neuropsychological outcome in children with malignant posterior fossa tumors

Abstract

Formal properties of ensemble density functionals are examined. Expressions for the difference between energy functionals where the particle number differs by one are constructed in terms of their first functional derivatives for the universal energy functional, the electron–electron repulsion energy functional, and the interacting kinetic energy functional. Equations that must be satisfied by second and higher order functional derivatives are derived. It is also shown that the shape of ${\delta V_{ee}[\rho]\over\delta\rho({\bf r})}$ and ${\delta K[\rho]\over\delta\rho({\bf r})}$, the functional derivatives of the mutual electron–electron repulsion, and kinetic energy, respectively, are separately particle number independent for particle numbers between successive integers. © 2013 Wiley Periodicals, Inc.

Microsurgical management of pediatric ependymomas of the fourth ventricle via the trans-cerebellomedullary fissure approach: A review of 26 cases

“…The traditional approach for removing ependymomas of the fourth ventricle is incision of the cerebellar vermis, which, however, is often associated with a higher incidence of cerebellar mutism or posterior fossa syndrome, along with chronic neurocognitive sequelae, compared with the trans-CMF appr oach (13,(18)(19)(20)(21)24,25,(41)(42)(43). The trans-CMF approach to the fourth ventricle, which does not cause significant injury to the neural tissue, was first proposed by Matsushima et al (36), and is currently widely accepted (8,13,14,(18)(19)(20)(22)(23)(24)(25)(26)(29)(30)(31)(32)36,43).…”

“…According to the existing literature (19,29), the bilateral trans-CMF approach appears to be associated with a high rate of postoperative mutism, compared with the unilateral approach. Despite the controversy surrounding the pathophysiological mechanisms, it is considered that the dentate nuclei and their connections with the thalamus through the brainstem participate in speech function; therefore injury to this pathway may result in mutism (12,14,20,21). Another explanation for this observation may be that the preservation of the contralateral CMF reduces the likelihood of blood vessel injury (particularly in branches of the PICA) during the unilateral approach.…”

“…Ependymomas of the fourth ventricle are usually approached with a posterior median craniotomy/craniectomy, followed by splitting of the vermis; however, this trans-vermian approach could easily injure the vermis, cerebellar dentate and globose nuclei, which may result in tremor, ataxia, atonia and cerebellar mutism, thereby affecting the prognosis (13,14,(18)(19)(20)(21)(22)(23)(24)(25). The establishment of the novel trans-cerebellomedullary fissure (CMF) approach, which provides sufficient access to the fourth ventricle without sacrificing the inferior vermis, has been associated with favorable outcomes (13,14,(18)(19)(20)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32).…”

Cerebellar mutism

“…In addition, Frassanito et al 31 reported a case of CM after spontaneous intratumoral bleeding involving the upper cerebellar vermis and believed that the localization of bleeding provided confirmation of the role played by the upper vermis in speech control. Puget et al 78 found that persistent clinical cerebellar signs or fine motor dexterity impairment was significantly related to the extent of injury (pre-or postsurgical) to both the inferior vermis and the dentate nuclei. Animal models were also used, and a recent study found that juvenile rats that had vermian splitting operations showed deficient social behavior and vocalization postoperatively, compared with sham-lesioned rats and healthy controls.…”

Tractografía de la vía dento-rubro-talámica en mutismo cerebeloso postoperatorio en niños con tumores de fosa posterior

“…En el mutismo cerebeloso y en el síndrome de mutismo cerebeloso el sustrato anatómico más citado en la literatura tiene relación con el núcleo dentado y el tracto dento-rubro-talámico [17][18][19][20][21][22][23] .…”