TY - JOUR
T1 - Cerebellar mutism
AU - Tamburrini, Gianpiero
AU - Frassanito, P.
AU - Chieffo, Daniela Pia Rosaria
AU - Massimi, Luca
AU - Caldarelli, M.
AU - Di Rocco, C.
PY - 2015
Y1 - 2015
N2 - 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.
AB - 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.
KW - Astrocytoma
KW - Cerebellum
KW - Ependymoma
KW - Humans
KW - Infratentorial Neoplasms
KW - Medulloblastoma
KW - Mutism
KW - Mutism and subsequent dysarthria
KW - Neurology (clinical)
KW - Neurosurgical Procedures
KW - Pediatrics
KW - Perinatology and Child Health
KW - Posterior cranial fossa syndrome
KW - Posterior fossa tumors
KW - Postoperative Complications
KW - Astrocytoma
KW - Cerebellum
KW - Ependymoma
KW - Humans
KW - Infratentorial Neoplasms
KW - Medulloblastoma
KW - Mutism
KW - Mutism and subsequent dysarthria
KW - Neurology (clinical)
KW - Neurosurgical Procedures
KW - Pediatrics
KW - Perinatology and Child Health
KW - Posterior cranial fossa syndrome
KW - Posterior fossa tumors
KW - Postoperative Complications
UR - https://publicatt.unicatt.it/handle/10807/124201
UR - https://www.scopus.com/inward/citedby.uri?partnerID=HzOxMe3b&scp=84941220283&origin=inward
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=84941220283&origin=inward
U2 - 10.1007/s00381-015-2803-6
DO - 10.1007/s00381-015-2803-6
M3 - Article
SN - 0256-7040
VL - 31
SP - 1841
EP - 1851
JO - Child's Nervous System
JF - Child's Nervous System
IS - 10
ER -