Mutism after Posterior Fossa Tumour Resection in Children: Incomplete Recovery on Long-Term Follow-Up

Steinbok, Paul; Cochrane, D. Douglas; Perrin, Richard G.; Price, Angela V.

doi:10.1159/000072468

Cited by 98 publications

(49 citation statements)

References 11 publications

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“…Replacement of the bone flap protects the area of surgical dissection and improves postoperative healing in addition to preserving the anatomy for potential future resections [18]. During the procedure, traction on the cerebellar hemispheres should be minimized to diminish development of pseudobulbar symptoms and cerebellar mutism [38,39,40]. …”

Section: Treatmentmentioning

confidence: 99%

Brainstem Tumors: Where Are We Today?

Recinos

Sciubba

Jallo³

2007

Pediatr Neurosurg

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Brainstem tumors comprise 10–20% of all pediatric central nervous system tumors. The management of these tumors has evolved dramatically in the past century. Once considered uniformly fatal, it is now known that brainstem tumors have distinguishing characteristics and do not behave identically. The focality and location of the lesion is determined from the clinical history, presentation, and associated imaging. Based on these findings, it is possible to predict the behavior of the tumor and choose an appropriate intervention. Focal lesions have a good prognosis and are treated operatively while diffuse lesions have a poor prognosis and are managed medically. This article reviews the current classification of brainstem tumors, current management options and future directions for the treatment of these rare tumors.

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Section: Treatmentmentioning

confidence: 99%

Brainstem Tumors: Where Are We Today?

Recinos

Sciubba

Jallo³

2007

Pediatr Neurosurg

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“…The 5-year survival rate in their study was slightly better but not significant for those with total tumor removal than for those with subtotal tumor removal (56 vs. 47%). None of our patients was diagnosed as having cerebellar mutism, which was reported to occur in 3.7-8.5% of children after resection of posterior fossa tumor [13,14]. The low incidence in our study is questionable because of its small sample size.…”

Section: Discussionmentioning

confidence: 55%

MULTIVARIATE SURVIVAL ANALYSIS OF CHILDREN WITH MEDULLOBLASTOMA—A Single-Center Experience

Chen

Liu

Jaing

et al. 2008

Pediatric Hematology and Oncology

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The authors sought to evaluate the treatment outcome of children with medulloblastoma at a single institution. Forty-two children were analyzed. Eighty-six percent of the children who received chemotherapy were treated with cisplatin-based chemotherapy. No factors were found to affect outcome significantly. Compared with children treated before 1994 at the same institution, the median survival time was significantly longer (40 vs. 25 months, p = .0003). The authors conclude that some improvement of treatment outcome for children with medulloblastoma seemed to be achieved.

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“…Huber et al 46 considered that motor speech deficits persist for a long period of time (> 5 years), and similar findings were made by other authors. 52,81,92 Lastly, Robertson et al 82 tried to analyze the neurological outcome of their patients, and they found that there is a significant relationship among the level of initial severity of the syndrome and the severity of ataxia and language dysfunction and global intellectual handicap after 1 year. It is worth mentioning than in a developing child such persistent symptoms have a lasting impact on global language and cognitive skills.…”

Section: Outcomementioning

confidence: 99%

Cerebellar mutism

Pitsika¹,

Tsitouras²

2013

PED

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Mutism of cerebellar origin is a well-described clinical entity that complicates operations for posterior fossa tumors, especially in children. This review focuses on the current understanding of principal pathophysiological aspects and risk factors, epidemiology, clinical characteristics, treatment strategies, and outcome considerations. The PubMed database was searched using the term cerebellar mutism and relevant definitions to identify publications in the English-language literature. Pertinent publications were selected from the reference lists of the previously identified articles. Over the last few years an increasing number of prospective studies and reviews have provided valuable information regarding the cerebellar mutism syndrome. Importantly, the clarification of principal terminology that surrounds the wide clinical spectrum of the syndrome results in more focused research and more effective identification of this entity. In children who undergo surgery for medulloblastoma the incidence of cerebellar mutism syndrome was reported to be 24%, and significant risk factors so far are brainstem involvement and midline location of the tumor. The dentate-thalamo-cortical tracts and lesions that affect their integrity are considered significant pathophysiological issues, especially the tract that originates in the right cerebellar hemisphere. Moderate and severe forms of the cerebellar mutism syndrome are the most frequent types during the initial presentation, and the overall neurocognitive outcome is not as favorable as thought in the earlier publications. Advanced neuroimaging techniques could contribute to identification of high-risk patients preoperatively and allow for more effective surgical planning that should focus on maximal tumor resection with minimal risk to important neural structures. Properly designed multicenter trials are needed to provide stronger evidence regarding effective prevention of cerebellar mutism and the best therapeutic approaches for such patients with a combination of pharmacological agents and multidisciplinary speech and behavior augmentation.

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Mutism after Posterior Fossa Tumour Resection in Children: Incomplete Recovery on Long-Term Follow-Up

Cited by 98 publications

References 11 publications

Brainstem Tumors: Where Are We Today?

Brainstem Tumors: Where Are We Today?

MULTIVARIATE SURVIVAL ANALYSIS OF CHILDREN WITH MEDULLOBLASTOMA—A Single-Center Experience

Cerebellar mutism

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