Martin A Schaller-Paule1, Peter Baumgarten2, Volker Seifert2, Marlies Wagner3, Eike Steidl3,4,5, Elke Hattingen3, Felix Wicke6, Joachim P Steinbach4,5,7,8, Christian Foerch1, Juergen Konczalla2. 1. Department of Neurology, University Hospital Frankfurt, Goethe-University, 60528 Frankfurt am Main, Germany. 2. Department of Neurosurgery, University Hospital Frankfurt, Goethe-University, 60528 Frankfurt am Main, Germany. 3. Institute of Neuroradiology, University Hospital Frankfurt, Goethe-University, 60528 Frankfurt am Main, Germany. 4. University Cancer Center Frankfurt (UCT), University Hospital Frankfurt, Goethe-University, 60528 Frankfurt am Main, Germany. 5. German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz, 60528 Frankfurt am Main, Germany. 6. Department of Psychosomatic Medicine and Psychotherapy, Johannes Gutenberg University Mainz, 55131 Mainz, Germany. 7. Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, Goethe-University, 60528 Frankfurt am Main, Germany. 8. Frankfurt Cancer Institute (FCI), University Hospital Frankfurt, Goethe-University, 60528 Frankfurt am Main, Germany.
Abstract
Background: In brain tumor surgery, injury to cerebellar connectivity pathways can induce a neurodegenerative disease called hypertrophic olivary degeneration (HOD), along with a disabling clinical syndrome. In children, cerebellar mutism syndrome (CMS) is another consequence of damage to cerebello-thalamo-cortical networks. The goal of this study was to compare paravermal trans-cerebellar to other more midline or lateral operative approaches in their risk of causing HOD on MR-imaging and CMS. Methods: We scanned our neurosurgical database for patients with surgical removal of pilocytic astrocytoma, ependymoma and medulloblastoma in the posterior fossa. Fifty patients with a mean age of 22.7 (±16.9) years were identified and analyzed. Results: HOD occurred in n = 10/50 (20%) patients within four months (median), always associated with contralateral dentate nucleus (DN)-lesions (p < 0.001). Patients with paravermal trans-cerebellar approach significantly more often developed HOD (7/11; 63.6%) when compared to other approaches (3/39; 7.7%; p < 0.001). Injury to the DN occurred more frequently after a paravermal approach (8/11 vs. 13/39 patients; p < 0.05). CMS was described for n = 12/50 patients (24%). Data indicated no correlation of radiological HOD and CMS development. Conclusions: A paravermal trans-cerebellar approach more likely causes HOD due to DN-injury when compared to more midline or lateral approaches. HOD is a radiological indicator for surgical disruption of cerebellar pathways involving the DN. Neurosurgeons should consider trajectories and approaches in the planning of posterior fossa surgery that spare the DN, whenever feasible.
Background: In brain tumor surgery, injury to cerebellar connectivity pathways can induce a neurodegenerative disease called hypertrophic olivary degeneration (HOD), along with a disabling clinical syndrome. In children, cerebellar mutism syndrome (CMS) is another consequence of damage to cerebello-thalamo-cortical networks. The goal of this study was to compare paravermal trans-cerebellar to other more midline or lateral operative approaches in their risk of causing HOD on MR-imaging and CMS. Methods: We scanned our neurosurgical database for patients with surgical removal of pilocytic astrocytoma, ependymoma and medulloblastoma in the posterior fossa. Fifty patients with a mean age of 22.7 (±16.9) years were identified and analyzed. Results: HOD occurred in n = 10/50 (20%) patients within four months (median), always associated with contralateral dentate nucleus (DN)-lesions (p < 0.001). Patients with paravermal trans-cerebellar approach significantly more often developed HOD (7/11; 63.6%) when compared to other approaches (3/39; 7.7%; p < 0.001). Injury to the DN occurred more frequently after a paravermal approach (8/11 vs. 13/39 patients; p < 0.05). CMS was described for n = 12/50 patients (24%). Data indicated no correlation of radiological HOD and CMS development. Conclusions: A paravermal trans-cerebellar approach more likely causes HOD due to DN-injury when compared to more midline or lateral approaches. HOD is a radiological indicator for surgical disruption of cerebellar pathways involving the DN. Neurosurgeons should consider trajectories and approaches in the planning of posterior fossa surgery that spare the DN, whenever feasible.
Authors: Eike Steidl; Maximilian Rauch; Elke Hattingen; Stella Breuer; Jan Rüdiger Schüre; Marike Grapengeter; Manoj Shrestha; Christian Foerch; Martin A Schaller-Paule Journal: Front Neurol Date: 2022-08-03 Impact factor: 4.086
Authors: Martin A Schaller-Paule; Eike Steidl; Manoj Shrestha; Ralf Deichmann; Helmuth Steinmetz; Alexander Seiler; Sriramya Lapa; Thorsten Steiner; Sven Thonke; Stefan Weidauer; Juergen Konczalla; Elke Hattingen; Christian Foerch Journal: Front Neurol Date: 2021-07-16 Impact factor: 4.003