Camilla de Laurentis1,2, Paola M F Cristaldi1,2, Paola Rebora3, Maria Grazia Valsecchi3, Veronica Biassoni4, Elisabetta Schiavello4, Giorgio G Carrabba1,2, Andrea Trezza2, Francesco DiMeco5,6,7, Paolo Ferroli8, Giuseppe Cinalli9, Marco Locatelli6,10, Marco Cenzato11, Giuseppe Talamonti11, Marco M Fontanella12,13, Giannatonio Spena14, Roberto Stefini15, Claudio Bernucci16, Silvio Bellocchi17, Davide Locatelli18,19, Maura Massimino20, Carlo Giussani1,2. 1. Department of Medicine and Surgery, School of Medicine, University of Milano-Bicocca, Milan, Italy. 2. Neurosurgery Unit, Ospedale San Gerardo, Monza, Italy. 3. Bicocca Bioinformatics, Biostatistics and Bioimaging Centre - B4, School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy. 4. Pediatrics Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy. 5. Neurosurgery Unit 1, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy. 6. Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy. 7. Department of Neurological Surgery, John Hopkins Medical School, Baltimore, MD, USA. 8. Neurosurgery Unit 2, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy. 9. Pediatric Neurosurgery Unit, Santobono-Pausilipon Children's Hospital, AORN, Naples, Italy. 10. Neurosurgery Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy. 11. Neurosurgery Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy. 12. Neurosurgery Unit, ASST Spedali Civili di Brescia, Brescia, Italy. 13. Department of Medicine and Surgery, Università degli Studi di Brescia, Brescia, Italy. 14. Neurosurgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy. 15. Neurosurgery Unit, Ospedale Civile di Legnano, Legnano, Italy. 16. Neurosurgery Unit, ASST Papa Giovanni XXIII, Bergamo, Italy. 17. Neurosurgery Unit, Ospedale Sant'Anna, San Fermo della Battaglia, Italy. 18. Neurosurgery Unit, Ospedale di Circolo, Varese, Italy. 19. Department of Medicine and Surgery, Università dell'Insubria, Varese, Italy. 20. Pediatrics Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy. maura.massimino@istitutotumori.mi.it.
Abstract
INTRODUCTION: Posterior fossa syndrome (PFS) is a set of debilitating complications that can occur after surgery for posterior fossa tumors. This study aimed to assess the preoperative radiological and surgical risk factors for the onset of PFS in a histologically homogeneous population of children with medulloblastoma and compare it to a similar population of young adults. METHODS: Included patients underwent posterior fossa surgery for medulloblastoma at 11 Italian neurosurgical wards (2003-2019) and were referred to Fondazione IRCCS Istituto Nazionale dei Tumori in Milan (INT) for postoperative treatments. We collected patients' pre- and post-operative clinical, surgical and radiological data from the INT charts. To compare the distribution of variables, we used the Mann-Whitney and Fisher tests for continuous and categorical variables, respectively. RESULTS: 136 patients (109 children and 27 young adults) were included in the study. Among children, 29 (27%) developed PFS, and all of them had tumors at midline site with invasion of the fourth ventricle. Radiological evidence of involvement of the right superior (39% versus 12%; p = 0.011) or middle cerebellar peduncles (52% versus 18%; p = 0.002) seemed more common in children who developed PFS. Young adults showed an expected lower incidence of PFS (4 out of 27; 15%), that may be due to anatomical, physiological and oncological elements. CONCLUSIONS: This study confirmed some factors known to be associated with PFS onset and shed light on other debated issues. Our findings enhance an already hypothesized role of cerebellar language lateralization. The analysis of a population of young adults may shed more light on the often-neglected existence of PFS in non-pediatric patients.
INTRODUCTION: Posterior fossa syndrome (PFS) is a set of debilitating complications that can occur after surgery for posterior fossa tumors. This study aimed to assess the preoperative radiological and surgical risk factors for the onset of PFS in a histologically homogeneous population of children with medulloblastoma and compare it to a similar population of young adults. METHODS: Included patients underwent posterior fossa surgery for medulloblastoma at 11 Italian neurosurgical wards (2003-2019) and were referred to Fondazione IRCCS Istituto Nazionale dei Tumori in Milan (INT) for postoperative treatments. We collected patients' pre- and post-operative clinical, surgical and radiological data from the INT charts. To compare the distribution of variables, we used the Mann-Whitney and Fisher tests for continuous and categorical variables, respectively. RESULTS: 136 patients (109 children and 27 young adults) were included in the study. Among children, 29 (27%) developed PFS, and all of them had tumors at midline site with invasion of the fourth ventricle. Radiological evidence of involvement of the right superior (39% versus 12%; p = 0.011) or middle cerebellar peduncles (52% versus 18%; p = 0.002) seemed more common in children who developed PFS. Young adults showed an expected lower incidence of PFS (4 out of 27; 15%), that may be due to anatomical, physiological and oncological elements. CONCLUSIONS: This study confirmed some factors known to be associated with PFS onset and shed light on other debated issues. Our findings enhance an already hypothesized role of cerebellar language lateralization. The analysis of a population of young adults may shed more light on the often-neglected existence of PFS in non-pediatric patients.
Authors: J Siffert; T Y Poussaint; L C Goumnerova; R M Scott; B LaValley; N J Tarbell; S L Pomeroy Journal: J Neurooncol Date: 2000-05 Impact factor: 4.130
Authors: Thora Gudrunardottir; Angela T Morgan; Andrew L Lux; David A Walker; Karin S Walsh; Elizabeth M Wells; Jeffrey H Wisoff; Marianne Juhler; Jeremy D Schmahmann; Robert F Keating; Coriene Catsman-Berrevoets Journal: Childs Nerv Syst Date: 2016-05-03 Impact factor: 1.475
Authors: Jane E Schreiber; Shawna L Palmer; Heather M Conklin; Donald J Mabbott; Michelle A Swain; Melanie J Bonner; Mary L Chapieski; Lu Huang; Hui Zhang; Amar Gajjar Journal: Neuro Oncol Date: 2017-11-29 Impact factor: 12.300