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Perez-Roca E, Negreiros T, Casavilca-Zambrano S, Ojeda-Medina L, Díaz-Coronado R. Prognostic factors of pediatric ependymomas at a National Cancer Reference Center in Peru. Front Oncol 2024; 13:1331790. [PMID: 38298447 PMCID: PMC10828566 DOI: 10.3389/fonc.2023.1331790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 12/13/2023] [Indexed: 02/02/2024] Open
Abstract
Background Ependymomas are central nervous system tumors that significantly impact the quality of life and carry a high mortality rate. Both the disease itself and its treatment cause significant morbidity. At a national level in Peru, there are no reports on clinical characteristics of the disease. Methods This retrospective study captured patient aged less than 19 years with a diagnosis of ependymoma from 2012 to 2022 at a tertiary center in Lima. Results 85 patients were included with a median follow-up time was 51.6 months. The 5-year overall survival and progression-free survival were 55.89% (95% CI: 44.28 - 65.99) and 37.71% (95% CI: 26,21-49,16) respectively. The main prognostic factors identified were completed treatment (p=0.019), adjuvant chemotherapy (p=0.048), presence of metastasis (p=0.012), and disease recurrence (p=0.02). Conclusions The survival of patients with ependymoma is below that reported in high-income countries. Incomplete treatment and treatment abandonment are factors that negatively impact the prognosis. Further studies are needed to identify barriers in the referral and treatment process for patients with ependymoma.
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Affiliation(s)
| | - Tatiana Negreiros
- Radiotherapy Department, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | | | - Luis Ojeda-Medina
- Neurosurgery Department, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | - Rosdali Díaz-Coronado
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
- Pediatric Oncology Department, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
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Sciancalepore F, Fabozzi F, Albino G, Del Baldo G, Di Ruscio V, Laus B, Menegatti D, Premuselli R, Secco DE, Tozzi AE, Lacorte E, Vanacore N, Carai A, Mastronuzzi A. Frequency and characterization of cognitive impairments in patients diagnosed with paediatric central nervous system tumours: a systematic review. Front Oncol 2023; 13:1198521. [PMID: 37274224 PMCID: PMC10235613 DOI: 10.3389/fonc.2023.1198521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 05/03/2023] [Indexed: 06/06/2023] Open
Abstract
Background This systematic review has been conducted with the aim of characterizing cognitive deficits and analyzing their frequency in survivors of paediatric Central Nervous System tumours. Materials and methods All literature published up to January 2023 was retrieved searching the databases "PubMed", "Cochrane", "APA PsycInfo" and "CINAHL". The following set of pre-defined inclusion criteria were then individually applied to the selected articles in their full-text version: i) Retrospective/prospective longitudinal observational studies including only patients diagnosed with primary cerebral tumours at ≤ 21 years (range 0-21); ii) Studies including patients evaluated for neuro-cognitive and neuro-psychological deficits from their diagnosis and/or from anti-tumoral therapies; iii) Studies reporting standardized tests evaluating patients' neuro-cognitive and neuro-psychological performances; iv) Patients with follow-ups ≥ 2 years from the end of their anti-tumoral therapies; v) Studies reporting frequencies of cognitive deficits. Results 39 studies were included in the analysis. Of these, 35 assessed intellectual functioning, 30 examined memory domains, 24 assessed executive functions, 22 assessed attention, 16 examined visuo-spatial skills, and 15 explored language. A total of 34 studies assessed more than one cognitive function, only 5 studies limited their analysis on a single cognitive domain. Attention impairments were the most recurrent in this population, with a mean frequency of 52.3% after a median period post-treatment of 11.5 years. The other cognitive functions investigated in the studies showed a similar frequency of impairments, with executive functions, language, visuospatial skills and memory deficits occurring in about 40% of survivors after a similar post-treatment period. Longitudinal studies included in the systematic review showed a frequent decline over time of intellectual functioning. Conclusions Survivors of paediatric Central Nervous System tumours experience cognitive sequelae characterized by significant impairments in the attention domain (52.3%), but also in the other cognitive functions. Future studies in this research field need to implement more cognitive interventions and effective, but less neurotoxic, tumour therapies to preserve or improve neurocognitive functioning and quality of life of this population.
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Affiliation(s)
- Francesco Sciancalepore
- National Center for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome, Italy
| | - Francesco Fabozzi
- Department of Oncology/Hematology, Cell Therapy Gene Therapies and Hemopoietic Transplant, Scientific Institute for Research, Hospitalization and Healthcare Bambino Gesù Children’s Hospital, Rome, Italy
- Department of Pediatrics, University of Tor Vergata, Rome, Italy
| | - Giulia Albino
- Department of Oncology/Hematology, Cell Therapy Gene Therapies and Hemopoietic Transplant, Scientific Institute for Research, Hospitalization and Healthcare Bambino Gesù Children’s Hospital, Rome, Italy
| | - Giada Del Baldo
- Department of Oncology/Hematology, Cell Therapy Gene Therapies and Hemopoietic Transplant, Scientific Institute for Research, Hospitalization and Healthcare Bambino Gesù Children’s Hospital, Rome, Italy
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Valentina Di Ruscio
- Department of Oncology/Hematology, Cell Therapy Gene Therapies and Hemopoietic Transplant, Scientific Institute for Research, Hospitalization and Healthcare Bambino Gesù Children’s Hospital, Rome, Italy
| | | | - Danilo Menegatti
- University of Rome “La Sapienza”, Department of Computer, Control, and Management Engineering (DIAG), Rome, Italy
| | - Roberto Premuselli
- Department of Oncology/Hematology, Cell Therapy Gene Therapies and Hemopoietic Transplant, Scientific Institute for Research, Hospitalization and Healthcare Bambino Gesù Children’s Hospital, Rome, Italy
| | - Domitilla Elena Secco
- Department of Oncology/Hematology, Cell Therapy Gene Therapies and Hemopoietic Transplant, Scientific Institute for Research, Hospitalization and Healthcare Bambino Gesù Children’s Hospital, Rome, Italy
| | - Alberto Eugenio Tozzi
- Multifactorial and Complex Diseases Research Area, Scientific Institute for Research, Hospitalization and Healthcare Bambino Gesù Children’s Hospital, Rome, Italy
| | - Eleonora Lacorte
- National Center for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome, Italy
| | - Nicola Vanacore
- National Center for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome, Italy
| | - Andrea Carai
- Neurosurgery Unit, Scientific Institute for Research, Hospitalization and Healthcare Bambino Gesù Children’s Hospital, Rome, Italy
| | - Angela Mastronuzzi
- Department of Oncology/Hematology, Cell Therapy Gene Therapies and Hemopoietic Transplant, Scientific Institute for Research, Hospitalization and Healthcare Bambino Gesù Children’s Hospital, Rome, Italy
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Zhu K, Yang W, Ying Z, Cai Y, Peng X, Zhang N, Sun H, Ji Y, Ge M. Long-term postoperative quality of life in childhood survivors with cerebellar mutism syndrome. Front Psychol 2023; 14:1130331. [PMID: 36910828 PMCID: PMC9998537 DOI: 10.3389/fpsyg.2023.1130331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 02/09/2023] [Indexed: 03/14/2023] Open
Abstract
Background To investigate the long-term quality of life (QoL) of children with cerebellar mutism syndrome (CMS) and explore the risk factors for a low QoL. Procedure This cross-sectional study investigated children who underwent posterior fossa surgery using an online Pediatric Quality of Life Inventory questionnaire. CMS and non-CMS patients were included to identify QoL predictors. Results Sixty-nine patients were included (male, 62.3%), 22 of whom had CMS. The mean follow-up time was 45.2 months. Children with CMS had a significantly lower mean QoL score (65.3 vs. 83.7, p < 0.001) and subdomain mean scores (physical; 57.8 vs. 85.3, p < 0.001; social: 69.5 vs. 85.1, p = 0.001; academic: p = 0.001) than those without CMS, except for the emotional domain (78.0 vs. 83.7, p = 0.062). Multivariable analysis revealed that CMS (coefficient = -14.748.61, p = 0.043), chemotherapy (coefficient = -7.629.82, p = 0.013), ventriculoperitoneal (VP) shunt placement (coefficient = -10.14, p = 0.024), and older age at surgery (coefficient = -1.1830, p = 0.007) were independent predictors of low total QoL scores. Physical scores were independently associated with CMS (coefficient = -27.4815.31, p = 0.005), VP shunt placement (coefficient = -12.86, p = 0.025), and radiotherapy (coefficient = -13.62, p = 0.007). Emotional score was negatively associated with age at surgery (coefficient = -1.92, p = 0.0337) and chemotherapy (coefficient = -9.11, p = 0.003). Social scores were negatively associated with male sex (coefficient = -13.68, p = 0.001) and VP shunt placement (coefficient = -1.36, p = 0.005), whereas academic scores were negatively correlated with chemotherapy (coefficient = -17.45, p < 0.001) and age at surgery (coefficient = -1.92, p = 0.002). Extent of resection (coefficient = 13.16, p = 0.021) was a good predictor of higher academic scores. Conclusion CMS results in long-term neurological and neuropsychological deficits, negatively affecting QoL, and warranting early rehabilitation.
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Affiliation(s)
- Kaiyi Zhu
- Department of Cardiology, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China.,Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Yang
- Department of Neurosurgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Zesheng Ying
- Department of Neurosurgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yingjie Cai
- Department of Neurosurgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - XiaoJiao Peng
- Department of Neurosurgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Nijia Zhang
- Department of Neurosurgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Hailang Sun
- Department of Neurosurgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yuanqi Ji
- Department of Neurosurgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Ming Ge
- Department of Neurosurgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
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Grønbæk JK, Boeg Thomsen D, Persson K, Mathiasen R, Juhler M. The Cerebellar Mutism Syndrome: Risk Assessment, Prevention and Treatment. Adv Tech Stand Neurosurg 2023; 46:65-94. [PMID: 37318570 DOI: 10.1007/978-3-031-28202-7_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Cerebellar mutism syndrome (CMS) has received increasing attention over the last decades as a complication of posterior fossa tumour surgery in children. Risk factors, aetiological aspects, and treatment measures of the syndrome have been investigated, yet the incidence of CMS remains unchanged. Overall, we are currently able to identify patients at risk, but we are unable to prevent it from occurring.Once CMS sets in, several symptomatic pharmacological treatments have been suggested, but only in smaller case series and not in randomized controlled trials, and it is not clear whether the treatment or time itself had a helpful effect.Within weeks to months, most patients regain their ability to speak after a phase with mutism or severely reduced speech; however, many patients continue to have speech and language deficits. At this point, anti-cancer treatment with chemotherapy and radiotherapy may be of focus more than the prognosis of CMS; however, many patients continue to have speech and language problems for months and years to come, and they are at high risk of other neurocognitive sequelae as well.Without reliable measures to prevent or treat the syndrome, we may look towards improving the prognosis of speech and neurocognitive functioning in these patients. As speech and language impairment is the cardinal symptom and late effect of CMS, the effect of intense and early-onset speech and language therapy as a standard of care in these patients should be investigated in relation to its effect on regaining speech capacity.
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Affiliation(s)
- Jonathan Kjær Grønbæk
- Department of Neurosurgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
| | - Ditte Boeg Thomsen
- Department of Cross-Cultural and Regional Studies, University of Copenhagen, Copenhagen, Denmark
| | - Karin Persson
- Department of Health Sciences, Lund University, Lund, Sweden
- Child and Youth Rehabilitation Services, Lund, Sweden
| | - René Mathiasen
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Marianne Juhler
- Department of Neurosurgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark
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Grønbæk JK, Wibroe M, Toescu S, Frič R, Thomsen BL, Møller LN, Grillner P, Gustavsson B, Mallucci C, Aquilina K, Fellows GA, Molinari E, Hjort MA, Westerholm-Ormio M, Kiudeliene R, Mudra K, Hauser P, van Baarsen K, Hoving E, Zipfel J, Nysom K, Schmiegelow K, Sehested A, Juhler M, Mathiasen R. Postoperative speech impairment and surgical approach to posterior fossa tumours in children: a prospective European multicentre cohort study. THE LANCET CHILD & ADOLESCENT HEALTH 2021; 5:814-824. [PMID: 34624241 DOI: 10.1016/s2352-4642(21)00274-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/16/2021] [Accepted: 08/17/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Brain tumours are the most common solid tumours in childhood. Half of these tumours occur in the posterior fossa, where surgical removal is complicated by the risk of cerebellar mutism syndrome, of which postoperative speech impairment (POSI) is a cardinal symptom, in up to 25% of patients. The surgical approach to midline tumours, mostly undertaken by transvermian or telovelar routes, has been proposed to influence the risk of POSI. We aimed to investigate the risk of developing POSI, the time course of its resolution, and its association with surgical approach and other clinical factors. METHODS In this observational prospective multicentre cohort study, we included children (aged <18 years) undergoing primary surgery for a posterior fossa tumour at 26 centres in nine European countries. Within 72 h of surgery, the operating neurosurgeon reported details on the tumour location, surgical approach used, duration of surgery, use of traction, and other predetermined factors, using a standardised surgical report form. At 2 weeks, 2 months, and 1 year after surgery, a follow-up questionnaire was filled out by a paediatrician or neurosurgeon, including neurological examination and assessment of speech. Speech was classified as mutism, reduced speech, or habitual speech. POSI was defined as either mutism or severely reduced speech. Ordinal logistic regression was used to analyse the risk of POSI. FINDINGS Between Aug 11, 2014, and Aug 24, 2020, we recruited 500 children. 426 (85%) patients underwent primary tumour surgery and had data available for further analysis. 192 (45%) patients were female, 234 (55%) patients were male, 81 (19%) patients were aged 0-2 years, 129 (30%) were aged 3-6 years, and 216 (51%) were aged 7-17 years. 0f 376 with known postoperative speech status, 112 (30%) developed POSI, 53 (14%) developed mutism (median 1 day [IQR 0-2]; range 0-10 days), and 59 (16%) developed reduced speech after surgery (0 days [0-1]; 0-4 days). Mutually adjusted analyses indicated that the independent risk factors for development of POSI were younger age (linear spline, p=0·0087), tumour location (four levels, p=0·0010), and tumour histology (five levels, p=0·0030); surgical approach (six levels) was not a significant risk factor (p=0·091). Tumour location outside the fourth ventricle and brainstem had a lower risk of POSI (with fourth ventricle as reference, odds ratio (OR) for cerebellar vermis 0·34 [95% CI 0·14-0·77] and OR for cerebellar hemispheres 0·23 [0·07-0·70]). Compared with pilocytic or pilomyxoid astrocytoma, a higher risk of POSI was seen for medulloblastoma (OR 2·85 [1·47-5·60]) and atypical teratoid rhabdoid tumour (10·30 [2·10-54·45]). We did not find an increased risk of POSI for transvermian surgical approach compared with telovelar (0·89 [0·46-1·73]). Probability of speech improvement from mutism reached 50% around 16 days after mutism onset. INTERPRETATION Our data suggest that a midline tumour location, younger age, and high-grade tumour histology all increase the risk of speech impairment after posterior fossa tumour surgery. We found no evidence to recommend a preference for telovelar over transvermian surgical approach in the management of posterior fossa tumours in children in relation to the risk of developing POSI. FUNDING The Danish Childhood Cancer Foundation, the Swedish Childhood Cancer Foundation, the UK Brain Tumour Charity, the Danish Cancer Society, Det Kgl Kjøbenhavnske Skydeselskab og Danske Broderskab, the Danish Capitol Regions Research Fund, Dagmar Marshall Foundation, Rigshospitalet's Research Fund, and Brainstrust.
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Affiliation(s)
- Jonathan Kjær Grønbæk
- Department of Neurosurgery, The University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Paediatrics and Adolescent Medicine, The University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Morten Wibroe
- Department of Paediatrics and Adolescent Medicine, The University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Sebastian Toescu
- Department of Neurosurgery, Great Ormond Street Hospital for Children, London, UK; Developmental Imaging and Biophysics Section, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Radek Frič
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
| | | | - Lisbeth Nørgaard Møller
- Department of Paediatrics and Adolescent Medicine, The University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Pernilla Grillner
- Pediatric Oncology Unit, Astrid Lindgrens Childrens Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Bengt Gustavsson
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
| | - Conor Mallucci
- Department of Paediatric Neurosurgery, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Kristian Aquilina
- Department of Neurosurgery, Great Ormond Street Hospital for Children, London, UK
| | - Greg Adam Fellows
- Department of Paediatric Neurosurgery, Bristol Royal Hospital for Children, Bristol, UK
| | - Emanuela Molinari
- Department of Neurology, The Queen Elizabeth University Hospital, University of Glasgow, Glasgow, UK
| | - Magnus Aasved Hjort
- Department of Pediatric Hematology and Oncology, St Olavs Hospital, Trondheim, Norway
| | | | - Rosita Kiudeliene
- Center of Pediatric Oncology and Hematology at Pediatric Department and Hospital of Kauno Klinikos, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Katalin Mudra
- 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Peter Hauser
- 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Pediatric Oncology and Transplantation Unit, Velkey László Child's Health Center, Borsod-Abaúj-Zemplén County University Teaching Hospital, Miskolc, Hungary
| | | | - Eelco Hoving
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Julian Zipfel
- Division of Pediatric Neurosurgery, Department of Neurosurgery, University Hospital Tübingen, Tübingen, Germany
| | - Karsten Nysom
- Department of Paediatrics and Adolescent Medicine, The University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Kjeld Schmiegelow
- Department of Paediatrics and Adolescent Medicine, The University Hospital Rigshospitalet, Copenhagen, Denmark; Institute of Clinical Medicine, Faculty of Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Astrid Sehested
- Department of Paediatrics and Adolescent Medicine, The University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Marianne Juhler
- Department of Neurosurgery, The University Hospital Rigshospitalet, Copenhagen, Denmark; Institute of Clinical Medicine, Faculty of Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark
| | - René Mathiasen
- Department of Paediatrics and Adolescent Medicine, The University Hospital Rigshospitalet, Copenhagen, Denmark.
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Zilli T, Dolcemascolo V, Passone E, Maieron M, De Colle MC, Skrap M, Ius T, Liguoro I, Venchiarutti M, Cogo P, Tomasino B. A multimodal approach to the study of children treated for posterior fossa tumor: A review of the literature and a pilot study. Clin Neurol Neurosurg 2021; 207:106819. [PMID: 34274656 DOI: 10.1016/j.clineuro.2021.106819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 06/24/2021] [Accepted: 07/02/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The aims of the present study were: (1) to review the literature on long-lasting cognitive sequelae in children treated for Posterior Fossa Tumor and (2) to investigate anatomic functional relations in a case series of 7 children treated for PFT using magnetic resonance imaging (MRI) post-processing methods. METHODS We retrospectively analyzed MRIs of children who underwent complete surgical resection of PFT and performed extensive neuropsychological evaluation. Tumor, ventricular volumes, and VPS insertion site were drawn on T1 volumetric MRI scans and normalized to a pediatric template. Children showed worse performances on tasks tapping executive functions, memory, visuo-motor precision, and expressive language. RESULTS Volumes of interest related to these functions showed a maximum overlap on the left vermis and the lateral ventricle enlargement, except for impaired narrative fluency -which was associated with left lateral ventricle enlargement- and narrative memory -which was related to the right vermis and the enlarged fourth ventricle. CONCLUSION Results suggest that anatomic functional relations in children treated for PFT are related to a combination of different pathophysiological factors.
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Affiliation(s)
- Tiziana Zilli
- Scientific Institute Eugenio Medea, Via della Bontà n. 7, 33078 San Vito al Tagliamento, PN, Italy.
| | - Valentina Dolcemascolo
- Division of Pediatrics, Department of Medicine, University Hospital of Udine, Piazzale S.M. della Misericordia 15, 33100, Italy
| | - Eva Passone
- Division of Pediatrics, Department of Medicine, University Hospital of Udine, Piazzale S.M. della Misericordia 15, 33100, Italy
| | - Marta Maieron
- Department of Medical Physics, University Hospital of Udine, P.le S.M. della Misericordia 15, 33100, Italy
| | - Maria Cristina De Colle
- Department of Neuroradiology, University Hospital of Udine, P.le S.M. della Misericordia 15, 33100, Italy
| | - Miran Skrap
- Department of Neurosurgery, University Hospital of Udine, P.le S.M. della Misericordia 15, 33100, Italy
| | - Tamara Ius
- Department of Neurosurgery, University Hospital of Udine, P.le S.M. della Misericordia 15, 33100, Italy
| | - Ilaria Liguoro
- Division of Pediatrics, Department of Medicine, University Hospital of Udine, Piazzale S.M. della Misericordia 15, 33100, Italy
| | - Martina Venchiarutti
- Division of Pediatrics, Department of Medicine, University Hospital of Udine, Piazzale S.M. della Misericordia 15, 33100, Italy; Child Neuropsychiatry, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, P.le L.A. Scuro 10, 37134, Italy
| | - Paola Cogo
- Division of Pediatrics, Department of Medicine, University Hospital of Udine, Piazzale S.M. della Misericordia 15, 33100, Italy
| | - Barbara Tomasino
- Scientific Institute Eugenio Medea, Via della Bontà n. 7, 33078 San Vito al Tagliamento, PN, Italy
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Shah SN, Al-Dandan SW, Shuja M, Balbaid A, Bashir M, Alharbi M. Survival after therapy for pediatric ependymoma in a tertiary care center in Saudi Arabia. Ann Saudi Med 2020; 40:482-490. [PMID: 33307736 PMCID: PMC7733644 DOI: 10.5144/0256-4947.2020.482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND There is limited data from Saudi Arabia on the demographic characteristics, outcomes and effectiveness of different treatment modalities in children with intracranial ependymoma. OBJECTIVE Study the characteristics of pediatric ependymoma and outcomes of treatment modalities in Saudi Arabia. DESIGN Retrospective. SETTING Tertiary care center. PATIENTS AND METHODS Children with intracranial ependymoma who were younger than 14 years of age and treated between 2006 and 2015 were included in the study. Patients with prior radiation, chemo-therapy, or surgical resection at other centers were excluded. MAIN OUTCOME MEASURES Kaplan-Meier survival curves were used to estimate the event-free (EFS) and overall survival (OS) rates of the patients. SAMPLE SIZE 22. RESULTS Of the 22 children, 4 (18.2%) were less than three years old. All intracranial ependymomas had upfront surgical resection of the primary tumor. Gross total resection was achievable in 9 (42.9%) cases and subtotal resection in another 9 (42.9%). Near-total resection was done in 3 (14.3%) cases. Median time from surgery to start of radiotherapy was 62 days. RT was given to 17 (77.3%) patients. Both mean and median RT dose was 55.8 Gy. Only 5 (22.7%) of the children received chemotherapy. The median duration of follow-up was 5.38 years and the median time for EFS was 2.27 years. The cumulative OS rate of the study was 44.5%. The cumulative EFS survival rate of the study was 18.6%. Among demographic, pathological, radiological features, none had a statistically significant effect on the survival. CONCLUSIONS The outcomes are comparable to those reported by international investigators for similar populations. Further improvements can be achieved by avoiding delays in radiation therapy and adding molecular staging. LIMITATIONS The limited number of cases, retrospective nature, lack of molecular biology and size of the tumors. CONFLICT OF INTEREST None.
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Affiliation(s)
- Syed Nizam Shah
- From the Department of Pediatric Hematology and Oncology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Sadeq Wasil Al-Dandan
- From the Department of Pathology and Laboratory Medicine, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Muhammad Shuja
- From the Department of Radiation Oncology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ali Balbaid
- From the Department of Radiation Oncology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Mohammad Bashir
- From the Research Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Musa Alharbi
- From the Department of Pediatric Hematology and Oncology, King Fahad Medical City, Riyadh, Saudi Arabia
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8
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Neuropsychological Profile in Children with Posterior Fossa Tumors with or Without Postoperative Cerebellar Mutism Syndrome (CMS). THE CEREBELLUM 2020; 19:78-88. [PMID: 31832994 DOI: 10.1007/s12311-019-01088-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Cerebellar mutism syndrome (CMS) is a common surgical sequela in children following posterior fossa tumor (PFT) resection. Here, we analyze the neuropsychological features associated with PFT in children, focusing particularly on the differential profiles associated with the presence or absence of CMS after surgery. We further examine the effect of post-resection treatments, tumor type, and presence/absence of hydrocephalus on surgical outcome. Thirty-six patients diagnosed with PFT (19 with and 17 without CMS) and 34 age- and gender-matched healthy controls (HCs) were recruited. A comprehensive neuropsychological evaluation was conducted in all patients postoperatively and in HCs, including an assessment of general cognitive ability, motor skills, perception, language, memory, attention, executive functions, and academic competence. CMS was found to be a clinical marker of lower neuropsychological profile scores across all cognitive domains except auditory-verbal processing and visual memory tasks. PFT patients not presenting CMS exhibited milder impairment in intellectual functioning, motor tasks, reasoning, language, verbal learning and recall, attention, cognitive executive functions, and academic competence. High-grade tumors were associated with slower processing speed and verbal delayed recall as well as alterations in selective and sustained attention. Hydrocephalus was detrimental to motor functioning and nonverbal reasoning. Patients who had undergone surgery, chemotherapy, and radiotherapy presented impaired processing speed, verbal learning, and reading. In addition to the deleterious effects of PFT, post-resection PFT treatments have a negative cognitive impact. These undesired consequences and the associated tumor-related damage can be assessed using standardized, long-term neuropsychological evaluation when planning rehabilitation.
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Beuriat PA, Cristofori I, Richard N, Bardi L, Loriette C, Szathmari A, Di Rocco F, Leblond P, Frappaz D, Faure-Conter C, Claude L, Mottolese C, Desmurget M. Cerebellar lesions at a young age predict poorer long-term functional recovery. Brain Commun 2020; 2:fcaa027. [PMID: 32954287 PMCID: PMC7425375 DOI: 10.1093/braincomms/fcaa027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 02/05/2020] [Accepted: 03/02/2020] [Indexed: 12/12/2022] Open
Abstract
Early studies on long-term functional recovery after motor and premotor lesions showed better outcomes in younger monkeys than in older monkeys. This finding led to the widespread belief that brain injuries cause less impairment in children than adults. However, this view has limitations and a large body of evidence now indicates that cerebral damages can be more harmful when inflicted at young age, during critical periods of neural development. To date, this issue has been mainly investigated in the context of focal and diffuse cortical lesions. Much less is known about the potential influence of early cerebellar damages. Several studies exist in survivor of posterior fossa tumours. However, in these studies, critical confounders were not always considered and contradictory conclusions were provided. We studied the impact or early cerebellar damage on long-term functional recovery in three groups of 15 posterior fossa survivors, comparable with respect to their tumour characteristics (type, size and location) but operated at different ages: young (≤7 years), middle (>7 and ≤13 years) and older (>13 years). Daily (health-related quality of life scale, performance status scale), motor (International Cooperative Ataxia Rating Scale, Pegboard Purdue Test) and cognitive (full-scale intelligence quotient) functioning were assessed. A general linear model controlling for age at surgery, radiotherapy, preservation of deep cerebellar nuclei, tumour volume and delay between surgery and assessment was used to investigate significant variations in outcome measures. Early age at surgery, lesion of deep cerebellar nuclei and postoperative radiotherapy had a significant, independent negative influence on long-term recovery. Tumour volume and delay between surgery and assessment had no statistically detectable impact. The negative influence of early age at surgery was significant in all domains: daily functioning (health-related quality of life scale, performance status scale), motor functioning (International Cooperative Ataxia Rating Scale, Pegboard Purdue Test) and cognitive functioning (full-scale intelligence quotient). These results support the existence of an early critical period of development during which the cerebellar ‘learning machine’ is of critical importance. Although the extent to which the early deficits here observed can be reversed needs now to be established, our data plead for the implementation of prompt and intense rehabilitation interventions in children operated before 7 years of age.
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Affiliation(s)
- Pierre-Aurélien Beuriat
- Institute of Cognitive Science Marc Jeannerod, CNRS/UMR 5229, 69500 Bron, France.,Université Claude Bernard Lyon 1, 69100 Villeurbanne, France.,Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, 69500 Bron, France
| | - Irene Cristofori
- Institute of Cognitive Science Marc Jeannerod, CNRS/UMR 5229, 69500 Bron, France.,Université Claude Bernard Lyon 1, 69100 Villeurbanne, France
| | - Nathalie Richard
- Institute of Cognitive Science Marc Jeannerod, CNRS/UMR 5229, 69500 Bron, France.,Université Claude Bernard Lyon 1, 69100 Villeurbanne, France
| | - Lara Bardi
- Institute of Cognitive Science Marc Jeannerod, CNRS/UMR 5229, 69500 Bron, France.,Université Claude Bernard Lyon 1, 69100 Villeurbanne, France
| | - Celia Loriette
- Institute of Cognitive Science Marc Jeannerod, CNRS/UMR 5229, 69500 Bron, France.,Université Claude Bernard Lyon 1, 69100 Villeurbanne, France
| | - Alexandru Szathmari
- Institute of Cognitive Science Marc Jeannerod, CNRS/UMR 5229, 69500 Bron, France.,Université Claude Bernard Lyon 1, 69100 Villeurbanne, France.,Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, 69500 Bron, France
| | - Federico Di Rocco
- Université Claude Bernard Lyon 1, 69100 Villeurbanne, France.,Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, 69500 Bron, France
| | - Pierre Leblond
- Department of Pediatric Hematology and Oncology, Institut d'hématologie et d'oncologie Pédiatrique, 69008 Lyon, France
| | - Didier Frappaz
- Department of Pediatric Hematology and Oncology, Institut d'hématologie et d'oncologie Pédiatrique, 69008 Lyon, France
| | - Cécile Faure-Conter
- Department of Pediatric Hematology and Oncology, Institut d'hématologie et d'oncologie Pédiatrique, 69008 Lyon, France
| | - Line Claude
- Department of Radiotherapy, Centre Léon Bérard, 69008 Lyon, France
| | - Carmine Mottolese
- Institute of Cognitive Science Marc Jeannerod, CNRS/UMR 5229, 69500 Bron, France.,Université Claude Bernard Lyon 1, 69100 Villeurbanne, France.,Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, 69500 Bron, France
| | - Michel Desmurget
- Institute of Cognitive Science Marc Jeannerod, CNRS/UMR 5229, 69500 Bron, France.,Université Claude Bernard Lyon 1, 69100 Villeurbanne, France
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10
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Ottensmeier H, Schlegel PG, Eyrich M, Wolff JE, Juhnke BO, von Hoff K, Frahsek S, Schmidt R, Faldum A, Fleischhack G, von Bueren A, Friedrich C, Resch A, Warmuth-Metz M, Krauss J, Kortmann RD, Bode U, Kühl J, Rutkowski S. Treatment of children under 4 years of age with medulloblastoma and ependymoma in the HIT2000/HIT-REZ 2005 trials: Neuropsychological outcome 5 years after treatment. PLoS One 2020; 15:e0227693. [PMID: 31971950 PMCID: PMC6977734 DOI: 10.1371/journal.pone.0227693] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 12/24/2019] [Indexed: 11/24/2022] Open
Abstract
Young children with brain tumours are at high risk of developing treatment-related sequelae. We aimed to assess neuropsychological outcomes 5 years after treatment. This cross-sectional study included children under 4 years of age with medulloblastoma (MB) or ependymoma (EP) enrolled in the German brain tumour trials HIT2000 and HIT-REZ2005. Testing was performed using the validated Wuerzburg Intelligence Diagnostics (WUEP-D), which includes Kaufman-Assessment-Battery, Coloured Progressive Matrices, Visual-Motor Integration, finger tapping “Speed”, and the Continuous Performance Test. Of 104 patients in 47 centres, 72 were eligible for analyses. We assessed whether IQ was impacted by disease extent, disease location, patient age, gender, age at surgery, and treatment (chemotherapy with our without craniospinal irradiation [CSI] or local radiotherapy [LRT]). Median age at surgery was 2.3 years. Testing was performed at a median of 4.9 years after surgery. Patients with infratentorial EPs (treated with LRT) scored highest in fluid intelligence (CPM 100.9±16.9, mean±SD); second best scores were achieved by patients with MB without metastasis treated with chemotherapy alone (CPM 93.9±13.2), followed by patients with supratentorial EPs treated with LRT. In contrast, lowest scores were achieved by patients that received chemotherapy and CSI, which included children with metastasised MB and those with relapsed MB M0 (CPM 71.7±8.0 and 73.2±21.8, respectively). Fine motor skills were reduced in all groups. Multivariable analysis revealed that type of treatment had an impact on IQ, but essentially not age at surgery, time since surgery or gender. Our results confirm previous reports on the detrimental effects of CSI in a larger cohort of children. Comparable IQ scores in children with MB treated only with chemotherapy and in children with EP suggest that this treatment strategy represents an attractive option for children who have a high chance to avoid application of CSI. Longitudinal follow-up examinations are warranted to assess long-term neuropsychological outcomes.
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Affiliation(s)
- Holger Ottensmeier
- Department of Paediatric Haematology and Oncology, University Children's Hospital, University Medical Center, Wuerzburg, Germany
- * E-mail:
| | - Paul G. Schlegel
- Department of Paediatric Haematology and Oncology, University Children's Hospital, University Medical Center, Wuerzburg, Germany
- Comprehensive Cancer Center Mainfranken, University Medical Center, Wuerzburg, Germany
| | - Matthias Eyrich
- Department of Paediatric Haematology and Oncology, University Children's Hospital, University Medical Center, Wuerzburg, Germany
| | - Johannes E. Wolff
- AbbvVie, Oncology Development, Chicago, Illinois, United States of America
| | - Björn-Ole Juhnke
- Department of Paediatric Haematology and Oncology, University Medical Centre, Hamburg-Eppendorf, Hamburg, Germany
| | - Katja von Hoff
- Department of Paediatric Haematology and Oncology, University Medical Centre, Hamburg-Eppendorf, Hamburg, Germany
| | - Stefanie Frahsek
- Department of Paediatric Haematology and Oncology, University Children's Hospital, University Medical Center, Wuerzburg, Germany
| | - Rene Schmidt
- Institute of Biostatistics and Clinical Research, University Muenster, Muenster, Germany
| | - Andreas Faldum
- Institute of Biostatistics and Clinical Research, University Muenster, Muenster, Germany
| | | | - Andre von Bueren
- Department of Paediatrics and Adolescent Medicine Division of Paediatric Haematology and Oncology, University Hospital of Geneva, Geneva, Switzerland
| | - Carsten Friedrich
- Department of Haematology Oncology, University Children´s Hospital Rostock, Rostock, Germany
| | - Anika Resch
- Department of Haematology Oncology, University Children´s Hospital Rostock, Rostock, Germany
| | - Monika Warmuth-Metz
- Department of Neuroradiology, HIT 2000 National Reference Center, University Medical Center Wuerzburg, Wuerzburg, Germany
| | - Jürgen Krauss
- Department of Paediatric Neurosurgery, University of Wuerzburg, University Medical Center Wuerzburg, Wuerzburg, Germany
| | - Rolf D. Kortmann
- Department of Radiotherapy, University of Leipzig, Leipzig, Germany
| | - Udo Bode
- Department of Paediatric Oncology, University of Bonn, Bonn, Germany
| | - Joachim Kühl
- Department of Paediatric Haematology and Oncology, University Children's Hospital, University Medical Center, Wuerzburg, Germany
| | - Stefan Rutkowski
- Department of Paediatric Haematology and Oncology, University Medical Centre, Hamburg-Eppendorf, Hamburg, Germany
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11
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Thorp N, Gandola L. Management of Ependymoma in Children, Adolescents and Young Adults. Clin Oncol (R Coll Radiol) 2019; 31:162-170. [PMID: 30616927 DOI: 10.1016/j.clon.2018.12.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 11/18/2018] [Accepted: 11/22/2018] [Indexed: 12/20/2022]
Abstract
Paediatric ependymomas are rare, malignant tumours arising throughout the central nervous system, but most frequently (in children) the posterior fossa. The standard of care for localised disease is gross total resection and focal radiotherapy, resulting in overall survival rates of up to 85%. Despite improvements in survival, treatment remains challenging, with persistently high rates of (rarely curable) relapse alongside risks of significant tumour and treatment-related toxicity. Systemic therapy is currently used to delay radiotherapy in very young children and in the management of metastatic or recurrent disease. Its use in the adjuvant setting is the subject of ongoing studies. Current research efforts are aimed at eliciting a better understanding of molecular biology, correlating this with tumour behaviour and defining targets for potential new agents. Prognosis seems to be related to the extent of surgical resection and the age at presentation. This article reviews clinical aspects of ependymoma management in children and young people.
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Affiliation(s)
- N Thorp
- Clatterbridge Cancer Centre, Wirral, UK.
| | - L Gandola
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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12
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Non-surgical transient cerebellar mutism-case report and systematic review. Childs Nerv Syst 2018; 34:535-540. [PMID: 29067507 DOI: 10.1007/s00381-017-3643-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 10/17/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Transient cerebellar mutism has been well recognized in literature as a complication of posterior fossa tumor resection. It is marked by profound impairment of fluency, articulation, and modulation of speech, irritability and autistic features and typically resolves within days to months. Underlying pathophysiology is debated, but currently unknown. METHODS We present a case of a child with similar clinical findings after cerebellitis, demonstration of diffuse cerebellar signal changes, swelling, and protruding tonsils at the level of foramen magnum. DISCUSSION To support the hypothesis that this clinical syndrome may occur in a non-surgical context, we present a review of literature of non-surgical transient cerebellar mutism.
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13
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14
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Theeler BJ, Gilbert MR. Investigating therapies in ependymoma. Expert Opin Orphan Drugs 2016. [DOI: 10.1080/21678707.2016.1191347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Brett J. Theeler
- Department of Neurology, Walter Reed National Military Medical Center, Neurology and John P. Murtha Cancer Center, Bethesda, MD, USA
| | - Mark R. Gilbert
- Neuro-Oncology Branch, National Institutes of Health, Bethesda, MD, USA
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15
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Consensus paper on post-operative pediatric cerebellar mutism syndrome: the Iceland Delphi results. Childs Nerv Syst 2016; 32:1195-203. [PMID: 27142103 DOI: 10.1007/s00381-016-3093-3] [Citation(s) in RCA: 121] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 04/13/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Confusion has surrounded the description of post-operative mutism and associated morbidity in pediatric patients with cerebellar tumors for years. The heterogeneity of definitions and diagnostic features has hampered research progress within the field, and to date, no international guidelines exist on diagnosis, prevention, treatment, or follow-up of this debilitating condition. An international group of clinicians and researchers from multiple relevant disciplines recently formed a cohesive panel to formulate a new working definition and agree upon standardized methods for diagnosis and follow-up. METHODS Consensus was obtained using the modified nominal group technique, involving four rounds of online Delphi questionnaires interspersed with a structured consensus conference with lectures, group work, and open discussion sessions. RESULTS A new, proposed definition of "post-operative pediatric CMS" was formed, preliminary recommendations for diagnostic and follow-up procedures were created, two working groups on a new scoring scale and risk prediction and prevention were established, and areas were identified where further information is needed. DISCUSSION The consensus process was motivated by desire to further research and improve quality of life for pediatric brain tumor patients. The Delphi rounds identified relevant topics and established basic agreement, while face-to-face engagement helped resolve matters of conflict and refine terminology. The new definition is intended to provide a more solid foundation for future clinical and research work. It is thought as a consensus for moving forward and hopefully paves the way to developing a standard approach to this challenging problem with the advent of better scoring methods and ultimate goal of reducing the risk of CMS.
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16
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Koustenis E, Hernáiz Driever P, de Sonneville L, Rueckriegel SM. Executive function deficits in pediatric cerebellar tumor survivors. Eur J Paediatr Neurol 2016; 20:25-37. [PMID: 26631949 DOI: 10.1016/j.ejpn.2015.11.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Revised: 10/30/2015] [Accepted: 11/01/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Besides motor function the cerebellum subserves frontal lobe functions. Thus, we investigated executive functions in pediatric posterior fossa tumor survivors. METHODS We tested information processing, aspects of attention, planning and intelligence in 42 pediatric posterior fossa tumor survivors (mean age 14.63 yrs, SD 5.03). Seventeen low-grade tumor patients (LGCT) were treated with surgery only and 25 high-grade tumors patients (HGCT) received postsurgical adjuvant treatment. We evaluated simple reaction time, executive functioning, i.e. visuospatial memory, inhibition, and mental flexibility using the Amsterdam Neuropsychological Tasks program, whereas forward thinking was assessed with the Tower of London-test. Intelligence was determined using the Wechsler Intelligence Scale. Ataxia was assessed with the International Cooperative Ataxia Rating Scale. RESULTS About one third of each patient group showed forward thinking scores below one standard deviation of the norm. Impaired forward thinking correlated significantly with degree of ataxia (r = -0.39, p = 0.03) but not with fluid intelligence. Both patient groups exhibited executive function deficits in accuracy and reaction speed in more difficult tasks involving information speed and attention flexibility. Still, HGCT patients were significantly slower and committed more errors. Working memory was inferior in HGCT patients. CONCLUSION Pediatric cerebellar tumor survivors with different disease and treatment related brain damage exhibit similar patterns of impairment in executive functioning, concerning forward thinking, inhibition and mental flexibility. The deficits are larger in high-grade tumor patients. The pattern of function loss seen in both groups is most probably due to comparable lesions to cerebro-cerebellar circuits that are known to modulate critical executive functions.
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Affiliation(s)
- Elisabeth Koustenis
- Department of Pediatric Oncology and Hematology, Charité-Universitätsmedizin Berlin, Germany
| | - Pablo Hernáiz Driever
- Department of Pediatric Oncology and Hematology, Charité-Universitätsmedizin Berlin, Germany.
| | - Leo de Sonneville
- Leiden Institute for Brain and Cognition, Department of Clinical Child and Adolescent Studies, Leiden University, The Netherlands
| | - Stefan M Rueckriegel
- Department of Pediatric Oncology and Hematology, Charité-Universitätsmedizin Berlin, Germany; Department of Neurosurgery, University Hospital Würzburg, Germany
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17
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Postoperative posterior fossa syndrome: unraveling the etiology and underlying pathophysiology by using magnetic resonance imaging. Childs Nerv Syst 2015; 31:1853-8. [PMID: 26143277 DOI: 10.1007/s00381-015-2796-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 06/19/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Posterior fossa syndrome (PFS) is a severe, postoperative complication occurring in about 25 % of pediatric patients undergoing surgery for midline tumors in the posterior fossa. In recent years, MRI-based research elucidated the cause of PFS and shed new light on its putative pathophysiology. This review highlights the major advances arising from research of this topic. RESULTS Postsurgical damage patterns in patients after posterior fossa surgery show that PFS results from bilateral surgical damage to the proximal efferent cerebellar pathways (pECPs). Surgical pECP disruption has other MRI-detectable effects that are more remote. Patients with PFS tend to develop global supratentorial cortical hypoperfusion, likely representing reversed, cerebello-cerebral diaschisis. Because this hypoperfusion is most prominent in frontal regions, cerebellar mutism may indicate a dominantly frontal lobe dysfunction, hence a peculiar form of speech apraxia. Injury to the pECP also leads to contralateral inferior olivary nucleus degeneration. When bilateral hypertrophic olivary degeneration (HOD) is observed after posterior fossa surgery, affected patients have clinical PFS. Therefore, it is suggested that bilateral HOD may be a sensitive and, in appropriate clinical settings, reliable a posteriori surrogate imaging indicator of bilateral disruption of the pECPs and consequently of PFS. Having such a "validation tool" presents new opportunities to develop better definitions for the phenotypes within the clinical spectrum of PFS. CONCLUSIONS Anatomical and functional MRI techniques are suitable and valuable tools with which to detect structural changes and pathophysiological processes in the development and evolution of PFS and may be key, integral components of future clinical research endeavors.
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18
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Abstract
INTRODUCTION Cerebellar mutism (CM) is defined as a peculiar form of mutism that may complicate the surgical excision of posterior cranial fossa tumor. The incidence is variable in the literature, occurring in up to one third of cases in some series. Commonly occurring peculiar features of CM are delayed onset following surgery, limited duration, and spontaneous recovery usually associated with dysarthria. METHODS A review has been performed concerning anatomical substrates and circuits actually considered to be involved in the development of cerebellar mutism, as well as risk factors for its development that have been documented in the literature. Attention has also been given to the long-term prognosis and the possibilities of rehabilitation that can be considered in these children, which has been compared with the authors' institutional experience. RESULTS AND CONCLUSIONS Tumor infiltration of the brainstem seems to represent the most relevant feature related to the development of CM, along with the histological diagnosis of medulloblastoma. On the other hand, hydrocephalus does not represent an independent risk factor. The higher rate of CM in children seems to be related to the higher incidence in children of tumors with malignant histology and brain stem involvement. Surgical technique does not seem to have a definite role; in particular, the use of a telovelar approach as compared to vermian split to reach the fourth ventricle extension of the tumor has not been demonstrated to prevent the development of cerebellar mutism. Concerning long-term prognosis, around one third of the children who develop cerebellar mutism after surgery have a persistent dysarthria, the remaining ones showing a residual phonological impairment. Long-term dysarthric features tend to be more severe and less prone to recovery in children presenting at diagnosis with associated combined procedural memory and defective neurocognitive functions.
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Spennato P, Nicosia G, Quaglietta L, Donofrio V, Mirone G, Di Martino G, Guadagno E, del Basso de Caro ML, Cascone D, Cinalli G. Posterior fossa tumors in infants and neonates. Childs Nerv Syst 2015; 31:1751-72. [PMID: 26351228 DOI: 10.1007/s00381-015-2783-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Accepted: 06/02/2015] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Management of posterior fossa tumors in infants and neonates is challenging. The characteristics of the young babies make surgery very difficult, sometimes precluding a safe complete removal. METHODS A review of the literature was undertaken to examine the incidence, histology, surgical aspects, and prognosis of posterior fossa tumors in the first year of life. Therapeutical strategies of the most frequent tumor types are also discussed in detail. RESULTS Histology is dominated by tumors with aggressive behavior, such as medulloblastomas, atypical teratoid/rhabdoid tumors, and anaplastic ependymomas. The most important surgical considerations in small children are the small circulating blood volume; the poor thermoregulation; and incomplete maturation of the brain, of the skull, and of the soft tissue. Treatment toxicity is inversely related to the age of the patients. Radiation therapy is usually considered as contraindicated in young children, with few exceptions. Proton therapy is a promising tool, but access to this kind of treatment is still limited. The therapeutic limitations of irradiation render resection of this tumor and adjuvant chemotherapy often the only therapeutic strategy in many cases. CONCLUSIONS The overall prognosis remains dismal because of the prevalent aggressive histologies, the surgical challenges, and the limitations of adjuvant treatment. Nevertheless, the impressive improvements in anesthesiology and surgical techniques allow, in the vast majority of the cases, complete removal of the lesions with minor sequelae in high-volume referral pediatric centers.
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Affiliation(s)
- Pietro Spennato
- Division of Neurosurgery, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Giancarlo Nicosia
- Division of Neurosurgery, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Lucia Quaglietta
- Division of Oncology, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Vittoria Donofrio
- Division of Pathology, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Giuseppe Mirone
- Division of Neurosurgery, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Giuliana Di Martino
- Division of Neurosurgery, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Elia Guadagno
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | | | - Daniele Cascone
- Division of Neuroradiology, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Giuseppe Cinalli
- Division of Neurosurgery, Santobono-Pausilipon Children's Hospital, Naples, Italy.
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20
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Hanzlik E, Woodrome SE, Abdel-Baki M, Geller TJ, Elbabaa SK. A systematic review of neuropsychological outcomes following posterior fossa tumor surgery in children. Childs Nerv Syst 2015; 31:1869-75. [PMID: 26351236 DOI: 10.1007/s00381-015-2867-3] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 07/30/2015] [Indexed: 11/30/2022]
Abstract
PURPOSE Central nervous system tumors are the most common solid tumors in the pediatric population. As children with central nervous system (CNS) tumors are surviving into adolescence and adulthood, more research is being focused on the long-term cognitive outcomes of the survivors. This review examines the literature on different cognitive outcomes of survivors of different childhood posterior fossa CNS tumor types. METHODS The authors reviewed the literature for articles published from 2000 to 2012 about long-term neuropsychological outcomes of children diagnosed with posterior fossa brain tumors before the age of 18, which distinguished between histological tumor types, and had a minimum follow-up of 3 years. RESULTS The literature search returned 13 articles, and a descriptive analysis was performed comparing intelligence quotient (IQ), attention/executive function, and memory components of 456 survivors of childhood posterior fossa tumors. Four articles directly compared astrocytoma and medulloblastoma survivors and showed medulloblastoma survivors fared worse in IQ, attention/executive function, and memory measurements. Five articles reporting medulloblastomas found IQ, attention, and memory scores to be significantly below the standardized means. Articles examining astrocytoma survivors found IQ scores within the normal range for the population. Survivors of ependymomas reported 2/23 survivors impaired on IQ scores, while a second study reported a significant number of ependymoma survivors lower than the expected population norm. CONCLUSIONS Tumor histopathology and the type of postoperative adjuvant therapy seem to have a significant impact on the long-term neuropsychological complications of pediatric posterior fossa CNS tumor survivors. Age at diagnosis and treatment factors are important variables that affect the outcomes of the survivors.
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Affiliation(s)
- Emily Hanzlik
- Saint Louis University School of Medicine, Saint Louis, MO, USA
| | - Stacey E Woodrome
- Department of Psychology, SSM Cardinal Glennon Children's Medical Center, Saint Louis, MO, USA
| | - Mohamed Abdel-Baki
- Division of Hematology/Oncology, Department of Pediatrics, Saint Louis University School of Medicine, Saint Louis, MO, USA
| | - Thomas J Geller
- Division of Child Neurology, Department of Neurology and Psychiatry, Saint Louis University School of Medicine, Saint Louis, MO, USA
| | - Samer K Elbabaa
- Division of Pediatric Neurosurgery, Department of Neurological Surgery, Saint Louis University School of Medicine, 1465 South Grand Blvd, Suite 2705, Saint Louis, MO, 63104, USA.
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21
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Merchant TE, Sharma S, Xiong X, Wu S, Conklin H. Effect of cerebellum radiation dosimetry on cognitive outcomes in children with infratentorial ependymoma. Int J Radiat Oncol Biol Phys 2014; 90:547-53. [PMID: 25149660 DOI: 10.1016/j.ijrobp.2014.06.043] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Revised: 03/28/2014] [Accepted: 06/18/2014] [Indexed: 11/16/2022]
Abstract
PURPOSE Cognitive decline is a recognized effect of radiation therapy (RT) in children treated for brain tumors. The importance of the cerebellum and its contribution to cognition have been recognized; however, the effect of RT on cerebellum-linked neurocognitive deficits has yet to be explored. METHODS AND MATERIALS Seventy-six children (39 males) at a median 3.3 years of age (range, 1-17 years old) were irradiated for infratentorial ependymoma from 1997 to 2008. The total prescribed dose was 54 to 59.4 Gy administered to the postoperative tumor bed with 5- or 10-mm clinical target volume margin. Age-appropriate cognitive and academic testing was performed prior to the start of RT and was then repeated at 6 months and annually throughout 5 years. The anterior and posterior cerebellum and other normal brain volumes were contoured on postcontrast, T1-weighted postoperative magnetic resonance images registered to treatment planning computed tomography images. Mean doses were calculated and used with time after RT and other clinical covariates to model their effect on neurocognitive test scores. RESULTS Considering only the statistically significant rates in longitudinal changes for test scores and models that included mean dose, there was a correlation between mean infratentorial dose and intelligence quotient (IQ; -0.190 patients/Gy/year; P=.001), math (-0.164 patients/Gy/year; P=.010), reading (-0.137 patients/Gy/year; P=.011), and spelling scores (-0.147 patients/Gy/year; P=.012), where Gy was measured as the difference between the mean dose received by an individual patient and the mean dose received by the patient group. There was a correlation between mean anterior cerebellum dose and IQ scores (-0.116 patients/Gy/year; P=.042) and mean posterior cerebellum dose and IQ (-0.150 patients/Gy/year; P=.002), math (-0.120 patients/Gy/year; P=.023), reading (-0.111 patients/Gy/year; P=.012), and spelling (-0.117 patients/Gy/year; P=.015) scores. CONCLUSIONS Sparing portions of the cerebellum should be considered in RT planning for children with infratentorial ependymoma because of the potential impact of radiation dose on cognitive function.
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Affiliation(s)
- Thomas E Merchant
- Division of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.
| | - Shelly Sharma
- Division of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Xiaoping Xiong
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Shengjie Wu
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Heather Conklin
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee
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Adult brainstem ganglioglioma bulging into the fourth ventricle. FORMOSAN JOURNAL OF SURGERY 2014. [DOI: 10.1016/j.fjs.2014.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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23
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Gündüz HB, Yassa MİK, Ofluoğlu AE, Postalci L, Emel E. Cerebellar Mutism Syndrome After Posterior Fossa Surgery: A Report of Two Cases of Pilocytic Astrocytoma. Noro Psikiyatr Ars 2013; 50:368-371. [PMID: 28360572 DOI: 10.4274/npa.y6311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Accepted: 06/27/2012] [Indexed: 12/01/2022] Open
Abstract
Cerebellar mutism is a type of syndrome including decreased speech, hypotonia, ataxia and emotional instability which occurs after posterior fossa surgery. It has been first reported by Rekate et al. and Yonemasu in 1985. It is well known that long tract signs and lower cranial nerve involvement are not seen with this syndrome and understanding is preserved. However, the pathophysiology of cerebellar mutism has not been well clarified yet. It is mainly seen in patients with medulloblastoma and brainstem involvement. In this report, we present two extraordinary cases of cerebellar mutism after posterior fossa surgery. They were considered extraordinary because their hystopathological analysis results yielded pilocytic astrocytoma which is out of the predefined risk factors.
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Affiliation(s)
- Hasan Burak Gündüz
- Bakırköy Prof. Dr. Mazhar Osman Mental Health and Neurology Training and Research Hospital, Clinic of 2 Neurosurgery, İstanbul, Turkey
| | - Mustafa İlker Kuntay Yassa
- Bakırköy Prof. Dr. Mazhar Osman Mental Health and Neurology Training and Research Hospital, Clinic of 1 Neurosurgery, İstanbul, Turkey
| | - Ali Ender Ofluoğlu
- Bakırköy Prof. Dr. Mazhar Osman Mental Health and Neurology Training and Research Hospital, Clinic of 2 Neurosurgery, İstanbul, Turkey
| | - Lütfü Postalci
- Bakırköy Prof. Dr. Mazhar Osman Mental Health and Neurology Training and Research Hospital, Clinic of 2 Neurosurgery, İstanbul, Turkey
| | - Erhan Emel
- Bakırköy Prof. Dr. Mazhar Osman Mental Health and Neurology Training and Research Hospital, Clinic of 2 Neurosurgery, İstanbul, Turkey
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Abstract
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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Affiliation(s)
- Marina Pitsika
- Department of Pediatric Neurosurgery, Mitera Children's Hospital, Athens, Greece
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Abstract
There is ample evidence that many children treated for brain tumors experience long-term neurocognitive deficits. The severity of those deficits is determined by a complex interaction of the child's genetic make-up and age, neuroanatomical damage caused by tumor and surgery, radiotherapy and chemotherapy, the psychosocial environment, and the intensity of targeted rehabilitation. The consequences of neurocognitive deficits are moderated by the number and severity of other deficits, including neurological and endocrine impairments, and this wider context must be considered. The impact of intellectual decline on academic functioning is evident, and underlies, for example, poor reading, writing, and mathematical skills. The effects of early brain damage on development are cumulative as more functions are expected to mature. Many survivors of CNS tumors can be expected to grow into deficits that have far-reaching consequences not only for academic achievement but also for their psychological and social development and their ability to be self-sufficient. Because the problems typically only become apparent over time, surveillance for their detection is an essential prerequisite for early educational and other interventions to support learning and successful transition to independent adult life.
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Affiliation(s)
- K S Bull
- Division of Clinical Neurosciences, School of Medicine, University of Southampton, Southampton, UK
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Abstract
Central nervous system tumors are the most frequent malignant tumor in children and the main cause of death in this age group after traffic accidents. The current estimates are that one adult in 2500 is a survivor of a brain tumor that occurred during childhood. These tumors are particularly heterogeneous in terms of histology/biology, treatment, and outcome. They share, however, a high risk of neurological and cognitive morbidity due to the disease itself and the treatment modalities (radiotherapy, surgery, and chemotherapy). Diagnosis is frequently delayed because symptoms are usually nonspecific at the beginning of the evolution. Posterior fossa is the most frequent site and the tumors present most frequently with signs of intracranial hypertension. Supratentorial tumors are more frequent in infants and in adolescents; seizures are not uncommon, especially for benign tumors. When adjuvant treatment is needed, radiotherapy is usually the mainstay apart from some histologies where chemotherapy may be sufficient: low-grade gliomas, desmoplastic medulloblastomas, malignant glial tumors in infants. Multidisciplinary care is best performed in tertiary care centers and should include early rehabilitation programs soon after surgery.
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Affiliation(s)
- Grill Jacques
- Brain Tumor Program, Department of Pediatric and Adolescent Oncology, Gustave Roussy Cancer Institute, Villejuif, France.
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27
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Intellectual impairment after treatment for medulloblastoma and astrocytoma in childhood: the Brazilian experience. J Pediatr Hematol Oncol 2011; 33:506-15. [PMID: 21941143 DOI: 10.1097/mph.0b013e3182260e7c] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND This study investigated the impact of posterior fossa tumors and their respective treatments, and the impact of clinical and sociodemographic variables, on the intelligence quotient (IQ) of Brazilian children. METHODS Twenty patients took part in the study, of which 13 were diagnosed with astrocytoma (average age at evaluation 10.2 y) and 7 with medulloblastoma (average age at evaluation 9.2 y). The first subgroup was submitted exclusively to tumor resection surgery and the second subgroup underwent surgery, chemotherapy (Vincristine, Cisplatine, and Carmustine), and radiotherapy (total dose of 54 Gy). The Wechsler Intelligence Scale for Children (WISCIII) was used. RESULTS The following statistically significant effects were identified: treatment modality on performance intelligence quotient scores (P=0.02) and processing speed index (PSI) (P=0.01); presence of hydrocephalus at diagnosis on verbal intelligence quotient (P=0.04); tumor localization on perceptual organization index (P=0.03); time interval between diagnosis and neuropsychological evaluation on PSI (P=0.05) and freedom from distraction index (P=0.03); and level of parental formal education on full scale IQ (P=0.02). CONCLUSIONS Exposure to radiotherapy has a significant effect on processing speed and consequently on global intellectual capacity. The impact on intelligence of clinical and sociodemographic variables such as tumor localization, time interval between diagnosis and cognitive evaluation, and parental level of formal education is confirmed in the specific setting of a developing country.
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Cerebellar mutism: definitions, classification and grading of symptoms. Childs Nerv Syst 2011; 27:1361-3. [PMID: 21732118 DOI: 10.1007/s00381-011-1509-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2011] [Accepted: 06/07/2011] [Indexed: 10/18/2022]
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Frassanito P, Massimi L. Cerebellar mutism: review of the literature. Childs Nerv Syst 2011; 27:867-8. [PMID: 21509568 DOI: 10.1007/s00381-011-1460-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Accepted: 04/07/2011] [Indexed: 11/26/2022]
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Gudrunardottir T, Sehested A, Juhler M, Schmiegelow K. Cerebellar mutism: review of the literature. Childs Nerv Syst 2011; 27:355-63. [PMID: 21061011 DOI: 10.1007/s00381-010-1328-2] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2010] [Accepted: 10/22/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE Cerebellar mutism is a common complication of posterior fossa surgery in children. This article reviews current status with respect to incidence, anatomical substrate, pathophysiology, risk factors, surgical considerations, treatment options, prognosis and prevention. METHODS We reviewed all peer-reviewed English publications on cerebellar mutism between the years of 1985 and 2009. The majority were found by searching for ‘cerebellar mutism’ and ‘posterior fossa syndrome’ in PubMed. Additional cases were identified by cross-checking reference lists. RESULTS The overall incidence of postoperative cerebellar mutism is 11-29%, and patients with medulloblastomas and/or brainstem invasion are at a greater risk of developing it than those with other kinds of tumors and/or without brainstem invasion. Permanent sequelae in the form of both motor- and non-motor-related speech deficits are common, especially when the right cerebellar hemisphere is involved. The mutism is caused by bilateral pertubation of the dentate nuclei and their efferent pathways, which emphasizes the need to explore surgical methods that spare these structures. The pathophysiological mechanisms of delayed onset and resolution of cerebellar mutism are not clear, but axonal damage, edema, perfusional defects and metabolic disturbances may be involved. CONCLUSION The incidence of cerebellar mutism is well documented in children with medulloblastoma, but precise figures for those with astrocytoma and ependymoma are lacking. Further anatomical, functional imaging and neuropsychological studies are needed to clarify the pathophysiological mechanisms in order to define preventive measures during surgery. Randomized, controlled trials of the effects of different medication and post-operative speech therapy are necessary for improving treatment.
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Affiliation(s)
- Thora Gudrunardottir
- Department of Pediatrics, The University Hospital Rigshospitalet, 2100 Copenhagen, Denmark
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Davis EE, Pitchford NJ, Jaspan T, McArthur DC, Walker DA. Effects of hydrocephalus after cerebellar tumor: a case-by-case approach. Pediatr Neurol 2011; 44:193-201. [PMID: 21310335 DOI: 10.1016/j.pediatrneurol.2010.09.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Revised: 08/31/2010] [Accepted: 09/22/2010] [Indexed: 11/28/2022]
Abstract
Although hydrocephalus affects approximately 80% of children with a posterior fossa tumor, its impact on neurodevelopmental outcomes remains unclear. We investigated the effects of hydrocephalus severity on the development of cognitive, motor, academic, and attention skills in 15 children with cerebellar injury after treatment for a tumor sustained during preschool years. Significant impairment was indicated by scores 2 S.D.s or more below the test norm mean. Results indicated substantial intra-individual and interindividual variation, with little consistent influence of hydrocephalus severity on outcomes. Generally, children with moderate hydrocephalus were least impaired, but the child without hydrocephalus performed most poorly. Those who received a shunt generally performed higher on many of the cognitive, but not motor, tests. Thus, when considering differences within and across individuals, neither hydrocephalus severity nor shunt placement alone is a strong predictor of neurodevelopmental outcomes.
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Affiliation(s)
- Emma E Davis
- School of Psychology, University of Nottingham, Nottingham, United Kingdom
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Szathmari A, Thiesse P, Galand-desmé S, Mottolese C, Bret P, Jouanneau E, Guyotat J, Lion-François L, Frappaz D. Correlation between pre- or postoperative MRI findings and cerebellar sequelae in patients with medulloblastomas. Pediatr Blood Cancer 2010; 55:1310-6. [PMID: 20981689 DOI: 10.1002/pbc.22802] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Immediate and delayed cerebellar dysfunction may be expected after surgical resection of a medulloblastoma. We investigated whether pre-operative and delayed post-operative MRI may correlate with such sequelae. MATERIAL AND METHODS The data of 31 patients in continuous complete remission after removal of medulloblastoma, irradiation and chemotherapy, were retrospectively reviewed. Magnetic Resonance Imaging (MRI) was analyzed for the following items: preoperative MRI (ratio of the surface of the tumor/posterior fossa, presence of ventricular dilatation or tonsilar hernia, involvement of the dentate nucleus) and delayed post-operative MRI (amount of cerebellar parenchyma removed, degree of cerebellar atrophy, presence of T1 hypointense regions in remaining cerebellar area and removal of region containing dentate nucleus). These data were correlated with immediate and long-term cerebellar syndrome and daily life repercussions. RESULTS On preoperative MRI, the ratio of the surface of the tumor/posterior fossa and the presence of tonsilar hernia were significantly correlated with long-term sequelae on speech (respectively P = 0.027 and P = 0.05). Initial supratentorial ventricular dilatation was correlated with ability to sustain adequately daily tasks (P = 0.002). On delayed MRI, cerebellar atrophy was inversely correlated with ability to sustain daily tasks (P = 0.002). Hypointense T1 territory in remaining cerebellar parenchyma significantly correlated with immediate post-operative cerebellar syndrome (P = 0.01) and showed a tendency for post-operative mutism (P = 0.087) but was not correlated with any long-term sequelae. CONCLUSION Increased cranial pressure on initial MRI and cerebellar atrophy detected on subsequent MRI studies correlated with immediate and long-term cerebellar sequelae.
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Affiliation(s)
- Alexandru Szathmari
- Pediatric Neurosurgical Department, Neurological and Neurosurgical Pierre Wertheimer Hospital, Lyon, France
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Kossorotoff M, Gonin-Flambois C, Gitiaux C, Quijano S, Boddaert N, Bahi-Buisson N, Barnerias C, Dulac O, Brunelle F, Desguerre I. A cognitive and affective pattern in posterior fossa strokes in children: a case series. Dev Med Child Neurol 2010; 52:626-31. [PMID: 20370817 DOI: 10.1111/j.1469-8749.2010.03616.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM Posterior fossa strokes account for about 10% of ischaemic strokes in children. Although motor and dysautonomic symptoms are common, to our knowledge cognitive and affective deficits have not been described in the paediatric literature. Our aim, therefore, was to describe these symptoms and deficits. METHOD In a retrospective study, we included all cases of posterior fossa strokes in children occurring at a single centre between 2005 and 2007, and investigated cognitive and affective deficits. RESULTS Five males aged 3 to 14 years met the inclusion criteria. They all presented very early with mood disturbances: outbursts of laughter and/or crying and alternating agitation or prostration that disappeared spontaneously within a few days. Persistent cognitive deficits were also diagnosed in all five: initial mutism, then anomia, followed by comprehension deficiency and deficiencies of planning ability, visual-spatial organization, and attention. Despite early and intensive rehabilitation, recovery from these cognitive deficits was slow and sometimes incomplete, and on follow-up they proved to be more disabling than the motor symptoms. INTERPRETATION These findings are similar to the cerebellar cognitive affective syndrome described in adults, and quite similar to the language and affective deficits observed in children after surgery for posterior fossa tumour. This is consistent with the role of the cerebellum and brainstem in affective and cognitive processes from early development.
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Affiliation(s)
- Manoelle Kossorotoff
- Paediatric Neurology Department, Hôpital Necker-Enfants Malades, APHP, 149 rue de Sévres, Paris, France.
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Di Pinto M, Conklin HM, Li C, Xiong X, Merchant TE. Investigating verbal and visual auditory learning after conformal radiation therapy for childhood ependymoma. Int J Radiat Oncol Biol Phys 2009; 77:1002-8. [PMID: 19783376 DOI: 10.1016/j.ijrobp.2009.06.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2009] [Revised: 05/27/2009] [Accepted: 06/02/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE The primary objective of this study was to determine whether children with localized ependymoma experience a decline in verbal or visual-auditory learning after conformal radiation therapy (CRT). The secondary objective was to investigate the impact of age and select clinical factors on learning before and after treatment. METHODS AND MATERIALS Learning in a sample of 71 patients with localized ependymoma was assessed with the California Verbal Learning Test (CVLT-C) and the Visual-Auditory Learning Test (VAL). Learning measures were administered before CRT, at 6 months, and then yearly for a total of 5 years. RESULTS There was no significant decline on measures of verbal or visual-auditory learning after CRT; however, younger age, more surgeries, and cerebrospinal fluid shunting did predict lower scores at baseline. There were significant longitudinal effects (improved learning scores after treatment) among older children on the CVLT-C and children that did not receive pre-CRT chemotherapy on the VAL. CONCLUSION There was no evidence of global decline in learning after CRT in children with localized ependymoma. Several important implications from the findings include the following: (1) identification of and differentiation among variables with transient vs. long-term effects on learning, (2) demonstration that children treated with chemotherapy before CRT had greater risk of adverse visual-auditory learning performance, and (3) establishment of baseline and serial assessment as critical in ascertaining necessary sensitivity and specificity for the detection of modest effects.
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Affiliation(s)
- Marcos Di Pinto
- Division of Behavioral Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
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Do we really need class 1 evidence results to give adjuvant radiation therapy to childhood intracranial ependymomas? Childs Nerv Syst 2009; 25:641-2; author reply 643-4. [PMID: 19337741 DOI: 10.1007/s00381-009-0847-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2009] [Indexed: 10/20/2022]
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Grill J, Puget S, De Carli E, Amoroso L, Taylor M, Brauner R, Leblond P, Kieffer V, Laurent-Vannier A, Dufour C, Bourgeois M, Wicart P, Dhermain F, Oppenheim D, Sainte-Rose C, Kalifa C. Tumeurs cérébrales de l’enfant : morbidité et suivi à l’âge adulte. Neurochirurgie 2008; 54:623-41. [DOI: 10.1016/j.neuchi.2008.07.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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