Federico Bianchi1, Daniela Pia Rosaria Chieffo2,3, Paolo Frassanito2, Concezio Di Rocco4, Gianpiero Tamburrini2,3. 1. Pediatric Neurosurgery, Institute of Neurosurgery and Institute of Infantile Neuropsychiatry, Fondazione Policlinico Gemelli IRCSS, Rome, Italy. fede0786@hotmail.it. 2. Pediatric Neurosurgery, Institute of Neurosurgery and Institute of Infantile Neuropsychiatry, Fondazione Policlinico Gemelli IRCSS, Rome, Italy. 3. Università Cattolica del Sacro Cuore, Rome, Italy. 4. Pediatric Neurosurgery, INI, Hannover, Germany.
Abstract
BACKGROUND: The association between preoperative language impairment and development of cerebellar mutism after surgical treatment of posterior fossa tumors has gained increasing interest in recent years based on the concept that both local compression/infiltration of the infratentorial periventricular anatomical structures involved in speech and language, as well as an increased distraction of supratentorial periventricular anatomical structures, due to an associated hydrocephalus, involved in the coordination of speech circuits, might lead to the subclinical presence of language disturbances already at diagnosis, predicting the development of a cerebellar mutism syndrome after tumor removal. METHODS: A thorough review of the literature on the subject has been performed, together with a review of our institutional experience reporting the related long-term (10 years) results. RESULTS AND CONCLUSIONS: According to our institutional experience, 20/70 (28.5%) children presented preoperative language impairment and developed cerebellar mutism after surgery. A residual impairment persists in 75% of the cases at a follow-up of 2 years, and in 50% of the cases at 10 years, a finding which actually depicts cerebellar mutism no more as a transient deficit but among long-term sequelae. The appearance of complex dysarthria in the postoperative period is a negative prognostic factor for the long-term persistence of speech disturbances.
BACKGROUND: The association between preoperative language impairment and development of cerebellar mutism after surgical treatment of posterior fossa tumors has gained increasing interest in recent years based on the concept that both local compression/infiltration of the infratentorial periventricular anatomical structures involved in speech and language, as well as an increased distraction of supratentorial periventricular anatomical structures, due to an associated hydrocephalus, involved in the coordination of speech circuits, might lead to the subclinical presence of language disturbances already at diagnosis, predicting the development of a cerebellar mutism syndrome after tumor removal. METHODS: A thorough review of the literature on the subject has been performed, together with a review of our institutional experience reporting the related long-term (10 years) results. RESULTS AND CONCLUSIONS: According to our institutional experience, 20/70 (28.5%) children presented preoperative language impairment and developed cerebellar mutism after surgery. A residual impairment persists in 75% of the cases at a follow-up of 2 years, and in 50% of the cases at 10 years, a finding which actually depicts cerebellar mutism no more as a transient deficit but among long-term sequelae. The appearance of complex dysarthria in the postoperative period is a negative prognostic factor for the long-term persistence of speech disturbances.
Entities:
Keywords:
Cerebellar mutism; Medulloblastoma; Posterior fossa tumor; Preoperative language impairment
Authors: Camilla de Laurentis; Paola M F Cristaldi; Paola Rebora; Maria Grazia Valsecchi; Veronica Biassoni; Elisabetta Schiavello; Giorgio G Carrabba; Andrea Trezza; Francesco DiMeco; Paolo Ferroli; Giuseppe Cinalli; Marco Locatelli; Marco Cenzato; Giuseppe Talamonti; Marco M Fontanella; Giannatonio Spena; Roberto Stefini; Claudio Bernucci; Silvio Bellocchi; Davide Locatelli; Maura Massimino; Carlo Giussani Journal: J Neurooncol Date: 2022-06-29 Impact factor: 4.506