Postoperative speech impairment and surgical approach to posterior fossa tumours in children: a prospective European multicentre cohort study

Grønbæk, Jonathan Kjær; Wibroe, Morten; Toescu, Sebastian; Frič, Radek; Thomsen, Birthe Lykke; Möller, Luciana M.; Grillner, Pernilla; Gustavsson, Bengt; Mallucci, Conor; Aquilina, Kristian; Molinari, Emanuela; Hjort, Magnus Aasved; Westerholm-Ormio, Mia; Kiudelienė, Rosita; Mudra, K; Hauser, Péter; Baarsen, Kirsten van; Hoving, Eelco W.; Zipfel, Julian; Nysom, Karsten; Schmiegelow, Kjeld; Sehested, Astrid; Juhler, Marianne; Mathiasen, René; Kjaersgaard, Mimi; Bøgeskov, Lars; Skjøth‐Rasmussen, Jane; Tamm, John Hauerberg; Poulsgaard, Lars; Gudrunardottir, Thora; Grønbæk, Sylvester Kløcker; Blichfeldt, Alberte; Raben-Levetzau, Felix Nicolai; Callesen, Michael; Rathe, Mathias; Klokker, Rikke Bassø; Öettingen, Gorm von; Mikkelsen, Torben Stamm; Henriksen, Louise Tram; Cortnum, Søren Ole Stigaard; Tofting-Olesen, Kamilla; Karppinen, Atte; Solem, Kristin; Torsvik, Ingrid Kristin; Mosand, Ann-Karin; Simonsen, Line Rapp; Ehrstedt, Christoffer; Kristiansen, Ingela; Fritzson, Karin; Haga, Line Balestrand; Fagerholt, Hege Kristine; Blixt, Helene Stømqvist; Sundgren, Hanna; Håkansson, Yvonne; Castor, Charlotte; Nyman, Per Olof; Wretman, Anne; Nilsson, Pelle; Bjørklund, Ann-Christin; Sabel, Magnus; Haij, Inga-Lill; Nilsson, Frans; Olausson, Hanna; Cummings, Claire; Flemming, Jade; Afolabi, Deborah; Phipps, Kim; Kamaly, Ian; Williams, Sharon E.; Jeelani, Noor-ul-Owase; McArthur, Donald; Wiles, Elisabeth; Walker, David; Cooper, Rebecca; Fellows, Greg; Hoole, Lizzy; Slater, Kirsty; Kandasamy, Jothy; McAndrew, Rachel; McLaughlin, Katie A.; Schumann, Martin; Avula, Shivaram; Pizer, Barry; Rutkauskienė, Giedrė; Matukevičius, Algimantas; Abbeele, Leonie van den; Markia, Balázs; Pálmafy, Beatrix; Clausen, Niels; Møller, Karen Margrethe Ottosen; Thomassen, Harald; Cappelen, Johan; Stensvold, Einar; Devennay, Irene; Lönnqvist, Tuula; Nordfors, Kristiina; Lähteenmäki, Päivi

doi:10.1016/s2352-4642(21)00274-1

Cited by 37 publications

(16 citation statements)

References 31 publications

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“… 4 A prospective study would also permit the integration and analysis of recently identified surgical risk factors excluded in this retrospective study, namely, surgical experience and extent of resection. 74 , 75 …”

Section: Discussionmentioning

confidence: 99%

Improved prediction of postoperative pediatric cerebellar mutism syndrome using an artificial neural network

Sidpra

Marcus

Löbel

et al. 2022

Neuro-Oncology Advances

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Background Postoperative paediatric cerebellar mutism syndrome (pCMS) is a common but severe complication which may arise following the resection of posterior fossa tumours in children. Two previous studies have aimed to preoperatively predict pCMS, with varying results. In this work, we examine the generalisation of these models and determine if pCMS can be predicted more accurately using an artificial neural network (ANN). Methods An overview of reviews was performed to identify risk factors for pCMS, and a retrospective dataset collected as per these defined risk factors from children undergoing resection of primary posterior fossa tumours. The ANN was trained on this dataset and its performance evaluated in comparison to logistic regression and other predictive indices via analysis of receiver operator characteristic curves. Area under the curve (AUC) and accuracy were calculated and compared using a Wilcoxon signed rank test, with p<0.05 considered statistically significant. Results 204 children were included, of whom 80 developed pCMS. The performance of the ANN (AUC 0.949; accuracy 90.9%) exceeded that of logistic regression (p<0.05) and both external models (p<0.001). Conclusion Using an ANN, we show improved prediction of pCMS in comparison to previous models and conventional methods.

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Section: Discussionmentioning

confidence: 99%

Improved prediction of postoperative pediatric cerebellar mutism syndrome using an artificial neural network

Sidpra

Marcus

Löbel

et al. 2022

Neuro-Oncology Advances

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“…Post-operative CMS is currently believed to occur due to the surgical injury of anatomical structures that connect the cerebellum to the brainstem: more specifically, there is increasing evidence from data collected based on advanced MRI studies such as diffusion sequences and tractography that damage to the proximal efferent cerebellar pathway (ECP) is likely to be considered as the anatomical substrate of postoperative CMS. The proximal ECP includes the dentate nucleus, the superior cerebellar peduncle, and its decussation in the mesencephalic tegmentum, while its fibers travel towards the red nucleus and the thalamus (dentato-rubro-thalamic tract, DRTT) (Grønbaek et al, 2021). In particular, significant results come from a study conducted on 28 children with medulloblastoma who underwent resective surgery (Wells et al, 2010): 11 (39%) of these children then developed CMS.…”

Section: The Role Of Cerebellum In Languagementioning

confidence: 99%

Cerebellar mutism syndrome: From pathophysiology to rehabilitation

Fabozzi

Margoni

Andreozzi

et al. 2022

Front. Cell Dev. Biol.

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Cerebellar mutism syndrome (CMS) is a common complication following surgical resection of childhood tumors arising in the posterior fossa. Alteration of linguistic production, up to muteness and emotional lability, generally reported at least 24 h after the intervention, is the hallmark of post-operative CMS. Other associated traits include hypotonia and other cerebellar motor signs, cerebellar cognitive-affective syndrome, motor deficits from the involvement of the long pathways, and cranial neuropathies. Recovery usually takes 6 months, but most children are burdened with long-term residual deficits. The pathogenic mechanism is likely due to the damage occurring to the proximal efferent cerebellar pathway, including the dentate nucleus, the superior cerebellar peduncle, and its decussation in the mesencephalic tegmentum. Proven risk factors include brain stem invasion, diagnosis of medulloblastoma, midline localization, tumor size, invasion of the fourth ventricle, invasion of the superior cerebellar peduncle, left-handedness, and incision of the vermis. Currently, rehabilitation is the cornerstone of the treatment of patients with cerebellar mutism syndrome, and it must consider the three main impaired domains, namely speech, cognition/behavior, and movement.

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“…Data on surgical morbidity are particularly rare in children and often restricted to tumors of the posterior fossa. 44 The currently largest series refers to ependymomas rather than gliomas. However, sufficient data exist on functional impairments, such as vision, and consecutive negative effects on quality of life (QOL) in children.…”

Section: Morbiditymentioning

confidence: 99%

Neurosurgery for eloquent lesions in children: state-of-the-art rationale and technical implications of perioperative neurophysiology

Krieg

Bernhard

Ille

et al. 2022

Neurosurgical Focus

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OBJECTIVE In adult patients, an increasing group of neurosurgeons specialize entirely in the treatment of highly eloquent tumors, particularly gliomas. In contrast, extensive perioperative neurophysiological workup for pediatric cases has been limited essentially to epilepsy surgery. METHODS The authors discuss radio-oncological and general oncological considerations based on the current literature and their personal experience. RESULTS While several functional mapping modalities facilitate preoperative identification of cortically and subcortically located eloquent areas, not all are suited for children. Direct cortical intraoperative stimulation is impractical in many young patients due to the reduced excitability of the immature cortex. Behavioral requirements also limit the utility of functional MRI and magnetoencephalography in children. In contrast, MRI-derived tractography and navigated transcranial magnetic stimulation are available across ages. Herein, the authors review the oncological rationale of function-guided resection in pediatric gliomas including technical implications such as personalized perioperative neurophysiology, surgical strategies, and limitations. CONCLUSIONS Taken together, these techniques, despite the limitations of some, facilitate the identification of eloquent areas prior to tumor surgery and radiotherapy as well as during follow-up of residual tumors.

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Postoperative speech impairment and surgical approach to posterior fossa tumours in children: a prospective European multicentre cohort study

Cited by 37 publications

References 31 publications

Improved prediction of postoperative pediatric cerebellar mutism syndrome using an artificial neural network

Improved prediction of postoperative pediatric cerebellar mutism syndrome using an artificial neural network

Cerebellar mutism syndrome: From pathophysiology to rehabilitation

Neurosurgery for eloquent lesions in children: state-of-the-art rationale and technical implications of perioperative neurophysiology

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