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Kameda-Smith MM, Ragulojan M, Elliott C, Bliss L, Moore H, Sader N, Alsuwaihel M, Tso MK, Dakson A, Ajani O, Yarascavitch B, Fleming A, Mehta V, Aminnejad M, Farrokhyar F, Singh SK. National multicentered retrospective review of clinical and intraoperative factors associated with the development of cerebellar mutism after pediatric posterior fossa tumor resection. Childs Nerv Syst 2024; 40:1339-1347. [PMID: 38279985 DOI: 10.1007/s00381-024-06292-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 01/14/2024] [Indexed: 01/29/2024]
Abstract
BACKGROUND Cerebellar mutism (CM) is characterized by a significant loss of speech in children following posterior fossa (PF) surgery. The biological origin of CM remains unclear and is the subject of ongoing debate. Significant recovery from CM is less likely than previously described despite rigorous multidisciplinary neuro-rehabilitational efforts. METHODS A national multi-centered retrospective review of all children undergoing PF resection in four midsized Canadian academic pediatric institutions was undertaken. Patient, tumor and surgical factors associated with the post-operative development of CM were reviewed. Retrospective identification of PF surgery patients including those developing and those that did not (internal control). RESULTS The study identified 258 patients across the 4 centers between 2010 and 2020 (mean age 6.73 years; 42.2% female). Overall, CM was experienced in 19.5% of patients (N = 50). Amongst children who developed CM histopathology included medulloblastoma (35.7%), pilocytic astrocytoma (32.6%) and ependymoma (17.1%). Intraoperative impression of adherence to the floor of the 4th ventricle was positive in 36.8%. Intraoperative abrupt changes in blood pressure and/or heart rate were identified in 19.4% and 17.8% of cases. The clinical resolution of CM was rated to be complete, significant resolution, slight improvement, no improvement and deterioration in 56.0%, 8.0%, 20.0%, 14.0% and 2.0%, respectively. In the cohort of children who experienced post-operative CM as compared to their no-CM counterpart, proportionally more tumors were felt to be adherent to the floor of the 4th ventricle (56.0% vs 49.5%), intraoperative extent of resection was a GTR (74% vs 68.8%) and changes in heart rate were noted (≥ 20% from baseline) (26.0% vs 15.9%). However, a multiple regression analysis identified only abrupt changes in HR (OR 5.97, CI (1.53, 23.1), p = 0.01) to be significantly associated with the development of post-operative CM. CONCLUSION As a devastating surgical complication after posterior fossa tumor surgery with variable clinical course, identifying and understanding the operative cues and revising intraoperative plans that optimizes the child's neurooncological and clinical outcome are essential.
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Affiliation(s)
- Michelle M Kameda-Smith
- Division of Neurosurgery, McMaster University, Hamilton, ON, Canada.
- Great Ormond Street Hospital for Children, London, England.
- Canadian Neurosurgery Research Collaborative (CNRC), Hamilton, Canada.
- McMaster Pediatric Brain Tumor Study Group (PBTSG), Hamilton, ON, Canada.
| | - Malavan Ragulojan
- McMaster Pediatric Brain Tumor Study Group (PBTSG), Hamilton, ON, Canada
| | - Cameron Elliott
- Canadian Neurosurgery Research Collaborative (CNRC), Hamilton, Canada
- Division of Neurosurgery, University of Alberta, Edmonton, AB, Canada
| | - Lori Bliss
- Division of Neurosurgery, University of Alberta, Edmonton, AB, Canada
| | - Hanna Moore
- Division of Neurosurgery, University of Alberta, Edmonton, AB, Canada
| | - Nicholas Sader
- Division of Neurosurgery, University of Calgary, Calgary, AB, Canada
| | | | - Michael K Tso
- Canadian Neurosurgery Research Collaborative (CNRC), Hamilton, Canada
- Division of Neurosurgery, University of Calgary, Calgary, AB, Canada
| | - Ayoub Dakson
- Canadian Neurosurgery Research Collaborative (CNRC), Hamilton, Canada
- Division of Neurosurgery, Dalhousie University, Halifax, NS, Canada
| | - Olufemi Ajani
- Great Ormond Street Hospital for Children, London, England
- McMaster Pediatric Brain Tumor Study Group (PBTSG), Hamilton, ON, Canada
| | - Blake Yarascavitch
- Division of Neurosurgery, McMaster University, Hamilton, ON, Canada
- McMaster Pediatric Brain Tumor Study Group (PBTSG), Hamilton, ON, Canada
| | - Adam Fleming
- McMaster Pediatric Brain Tumor Study Group (PBTSG), Hamilton, ON, Canada
| | - Vivek Mehta
- Division of Neurosurgery, University of Alberta, Edmonton, AB, Canada
| | - Minoo Aminnejad
- McMaster Pediatric Brain Tumor Study Group (PBTSG), Hamilton, ON, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Forough Farrokhyar
- Division of Neurosurgery, McMaster University, Hamilton, ON, Canada
- McMaster Pediatric Brain Tumor Study Group (PBTSG), Hamilton, ON, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Sheila K Singh
- Division of Neurosurgery, McMaster University, Hamilton, ON, Canada
- McMaster Pediatric Brain Tumor Study Group (PBTSG), Hamilton, ON, Canada
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Persson K, Boeg Thomsen D, Fyrberg Å, Castor C, Aasved Hjort M, Andreozzi B, Grillner P, Kjær Grønbæk J, Jakus J, Juhler M, Mallucci C, Mathiasen R, Molinari E, Pizer B, Sehested A, Troks-Berzinskiene A, van Baarsen K, Tiberg I. Preoperative word-finding difficulties in children with posterior fossa tumours: a European cross-sectional study. Childs Nerv Syst 2024; 40:87-97. [PMID: 37682305 PMCID: PMC10761395 DOI: 10.1007/s00381-023-06119-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 08/04/2023] [Indexed: 09/09/2023]
Abstract
PURPOSE Posterior fossa tumour surgery in children entails a high risk for severe speech and language impairments, but few studies have investigated the effect of the tumour on language prior to surgery. The current crosslinguistic study addresses this gap. We investigated the prevalence of preoperative word-finding difficulties, examined associations with medical and demographic characteristics, and analysed lexical errors. METHODS We included 148 children aged 5-17 years with a posterior fossa tumour. Word-finding ability was assessed by means of a picture-naming test, Wordrace, and difficulties in accuracy and speed were identified by cut-off values. A norm-based subanalysis evaluated performance in a Swedish subsample. We compared the demographic and medical characteristics of children with slow, inaccurate, or combined slow and inaccurate word finding to the characteristics of children without word-finding difficulties and conducted a lexical error analysis. RESULTS Thirty-seven percent (n = 55) presented with slow word finding, 24% (n = 35) with inaccurate word finding, and 16% (n = 23) with both slow and inaccurate word finding. Children with posterior fossa tumours were twice as slow as children in the norming sample. Right-hemisphere and brainstem location posed a higher risk for preoperative word-finding difficulties, relative to left-hemisphere location, and difficulties were more prevalent in boys than in girls. The most frequent errors were lack of response and semantically related sideordinated words. CONCLUSION Word-finding difficulties are frequent in children with posterior fossa tumours, especially in boys and in children with right-hemisphere and brainstem tumours. Errors resemble those observed in typical development and children with word-finding difficulties.
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Affiliation(s)
- K Persson
- Department of Health Sciences, Lund University, Box 117, 221 00, Lund, Sweden.
| | - D Boeg Thomsen
- Department of Nordic Studies and Linguistics, University of Copenhagen, Emil Holms Kanal 2, 2300, Copenhagen, Denmark
- Department of Neurosurgery, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen E, Denmark
| | - Å Fyrberg
- Department of Speech and Language Pathology, University of Gothenburg, Medicinaregatan 11, 405 30, Gothenburg, Sweden
| | - C Castor
- Department of Health Sciences, Lund University, Box 117, 221 00, Lund, Sweden
| | - M Aasved Hjort
- Department of Pediatric Hematology and Oncology, St Olavs Hospital, Postboks 3250 Torgarden, 7006, Trondheim, Norway
| | - B Andreozzi
- Department of Hematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - P Grillner
- Pediatric Oncology Unit, Astrid Lindgren's Children's Hospital, Karolinskavägen 6, 171 76, Stockholm, Sweden
| | - J Kjær Grønbæk
- Department of Neurosurgery, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen E, Denmark
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen E, Denmark
| | - J Jakus
- WOW Speech Studio, Üllői út 189, Budapest, 1091, Hungary
| | - M Juhler
- Department of Neurosurgery, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen E, Denmark
- Department of Neurosurgery, Aarhus University Hospital, Palle Juul-Jensens, Boulevard 99, 8200, Aarhus, Denmark
| | - C Mallucci
- Department of Neurosurgery, Alder Hey Children's NHS Foundation Trust, E. Prescot Road, Liverpool, L14 5AB, UK
| | - R Mathiasen
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen E, Denmark
| | - E Molinari
- University of Edinburgh, Old College, South Bridge, Edinburgh, EH8 9YL, UK
- Department of Neurology, The Queen Elizabeth University Hospital, University of Glasgow, University Avenue, Glasgow, G12 8QQ, UK
| | - B Pizer
- University of Liverpool, Brownlow Hill, Liverpool, L69 3BX, UK
| | - A Sehested
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen E, Denmark
| | - A Troks-Berzinskiene
- Department of Pediatrics, Lithuanian, University of Health Science, Mickeviciaus 9, 44307, Kaunas, Lithuania
| | - K van Baarsen
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
| | - I Tiberg
- Department of Health Sciences, Lund University, Box 117, 221 00, Lund, Sweden
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Ballestero M, de Oliveira RS. The importance of olivary hypertrophic degeneration as a differential diagnosis in cerebellar mutism syndrome. Childs Nerv Syst 2023; 39:319-320. [PMID: 36542117 DOI: 10.1007/s00381-022-05815-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 12/18/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Matheus Ballestero
- Medicine Department, Federal University of São Carlos, Washington Luis Highway, Km 235, São Carlos, São Paulo, 13565-905, Brazil. .,Department of Surgery and Anatomy, Faculty of Medicine, University of São Paulo-Ribeirao Preto, Ribeirao Preto, São Paulo, Brazil.
| | - Ricardo Santos de Oliveira
- Department of Surgery and Anatomy, Faculty of Medicine, University of São Paulo-Ribeirao Preto, Ribeirao Preto, São Paulo, Brazil
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