Post-operative pediatric cerebellar mutism syndrome and its association with hypertrophic olivary degeneration

Avula, Shivaram; Spiteri, Michaela; Kumar, Ram; Lewis, Emma; Harave, Srikrishna; Windridge, David; Ong, Chan Chang; Pizer, Barry

doi:10.21037/qims.2016.10.11

Cited by 40 publications

(33 citation statements)

References 27 publications

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“…Still, studies suggest at least some short-term risk for neurocognitive deficits within the first year post surgery [ 8 , 9 , 10 ]. For example, even with refined neurosurgical practice, the post-surgical complication of posterior fossa syndrome (also known as cerebellar mutism) still occurs in up to 31% of children with infratentorial tumors [ 11 ]. This poorly understood entity has been attributed to disruption of cerebello-thalamo-cerebral pathways and is characterized by a unique constellation of symptoms that emerge approximately 24–48 h after surgery, including diminished speech, ataxia, emotional/behavioral lability and apathy.…”

Section: Factors Related To Expression Of Late Effectsmentioning

confidence: 99%

Neurocognitive and Psychosocial Outcomes in Pediatric Brain Tumor Survivors

et al. 2018

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The late neurocognitive and psychosocial effects of treatment for pediatric brain tumor (PBT) represent important areas of clinical focus and ongoing research. Neurocognitive sequelae and associated problems with learning and socioemotional development negatively impact PBT survivors’ overall health-related quality of life, educational attainment and employment rates. Multiple factors including tumor features and associated complications, treatment methods, individual protective and vulnerability factors and accessibility of environmental supports contribute to the neurocognitive and psychosocial outcomes in PBT survivors. Declines in overall measured intelligence are common and may persist years after treatment. Core deficits in attention, processing speed and working memory are postulated to underlie problems with overall intellectual development, academic achievement and career attainment. Additionally, psychological problems after PBT can include depression, anxiety and psychosocial adjustment issues. Several intervention paradigms are briefly described, though to date research on innovative, specific and effective interventions for neurocognitive late effects is still in its early stages. This article reviews the existing research for understanding PBT late effects and highlights the need for innovative research to enhance neurocognitive and psychosocial outcomes in PBT survivors.

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Section: Factors Related To Expression Of Late Effectsmentioning

confidence: 99%

Neurocognitive and Psychosocial Outcomes in Pediatric Brain Tumor Survivors

et al. 2018

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“…Recently, both qualitative [54] and quantitative [55,56] (Figures 3 and 4). The most basic model of diffusion signal is the diffusion tensor [57].…”

Section: Structural Mrimentioning

confidence: 99%

Quantitative MRI in post-operative paediatric cerebellar mutism syndrome

Toescu

Hales²,

Aquilina

et al. 2018

European Journal of Radiology

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Post-operative paediatric cerebellar mutism syndrome (pCMS) occurs in around 25% of children undergoing surgery for cerebellar and fourth ventricular tumours. Reversible mutism is the hallmark of a syndrome which comprises severe motor, cognitive and linguistic deficits. Recent evidence from advanced neuroimaging studies has led to the current theoretical understanding of the condition as a form of diaschisis contingent on damage to efferent cerebellar circuitry. Tractography data derived from diffusion MRI studies have shown disruption of the dentato-rubrothalamo-cortical tract in patients with pCMS, and perfusion studies have indicated widespread supratentorial regions which may give rise to the florid signs and symptoms of pCMS. Given the difficulties in predicting pCMS from standard structural MRI, this review discusses findings from quantitative MRI modalities which have contributed to our understanding of this debilitating syndrome, and considers the goals and challenges which lie ahead in the field.

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“…The technique used to identify these salient features is known as recursive feature elimination (RFE). Similarly to previous studies by Spiteri et al (2015), the feature selection process has been applied as a filter method and is similar to the sequential feature selection algorithm (SFS) described in (Spiteri et al 2015;Avula et al 2016). The main difference between RFE and SFS is that instead of sequentially adding features to a subset, the algorithm starts off with the full set of features and iteratively removes the weakest feature (or features) at each iteration.…”

Section: Feature Selectionmentioning

confidence: 99%

Fully-Automated Identification of Imaging Biomarkers for Post-Operative Cerebellar Mutism Syndrome Using Longitudinal Paediatric MRI

et al. 2019

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Post-operative cerebellar mutism syndrome (POPCMS) in children is a post-surgical complication which occurs following the resection of tumors within the brain stem and cerebellum. High resolution brain magnetic resonance (MR) images acquired at multiple time points across a patient's treatment allow the quantification of localized changes caused by the progression of this syndrome. However, MR images are not necessarily acquired at regular intervals throughout treatment and are often not volumetric. This restricts the analysis to 2D space and causes difficulty in intra-and inter-subject comparison. To address these challenges, we have developed an automated image processing and analysis pipeline. Multi-slice 2D MR image slices are interpolated in space and time to produce a 4D volumetric MR image dataset providing a longitudinal representation of the cerebellum and brain stem at specific time points across treatment. The deformations within the brain over time are represented using a novel metric known as the Jacobian of deformations determinant. This metric, together with the changing grey-level intensity of areas within the brain over time, are analyzed using machine learning techniques in order to identify biomarkers that correspond with the development of POPCMS following tumor resection. This study makes use of a fully automated approach which is not hypothesis-driven. As a result, we were able to automatically detect six potential biomarkers that are related to the development of POPCMS following tumor resection in the posterior fossa.

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Post-operative pediatric cerebellar mutism syndrome and its association with hypertrophic olivary degeneration

Cited by 40 publications

References 27 publications

Neurocognitive and Psychosocial Outcomes in Pediatric Brain Tumor Survivors

Neurocognitive and Psychosocial Outcomes in Pediatric Brain Tumor Survivors

Quantitative MRI in post-operative paediatric cerebellar mutism syndrome

Fully-Automated Identification of Imaging Biomarkers for Post-Operative Cerebellar Mutism Syndrome Using Longitudinal Paediatric MRI

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