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Cerebellar mutism

Review of the literature

  • Review Paper
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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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Article 09 September 2015

G. Tamburrini, P. Frassanito, … C. Di Rocco

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Acknowledgements

This study received financial support from The Childhood Cancer Foundation, Denmark. Kjeld Schmiegelow holds the Danish Childhood Cancer Foundation Professorship in Pediatric Oncology. The authors wish to thank Dr. Flemming Finn Madsen for his assistance in the preparation of the manuscript.

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Authors and Affiliations

  1. Department of Pediatrics, The University Hospital Rigshospitalet, 2100, Copenhagen, Denmark

    Thora Gudrunardottir, Astrid Sehested & Kjeld Schmiegelow

  2. Department of Neurosurgery, The University Hospital Rigshospitalet, 2100, Copenhagen, Denmark

    Marianne Juhler

  3. The Faculty of Medicine, Institute of Gynecology, Obstetrics and Pediatrics, University of Copenhagen, 2200, Copenhagen, Denmark

    Kjeld Schmiegelow

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  1. Thora Gudrunardottir
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Correspondence to Kjeld Schmiegelow.

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Gudrunardottir, T., Sehested, A., Juhler, M. et al. Cerebellar mutism. Childs Nerv Syst 27, 355–363 (2011). https://doi.org/10.1007/s00381-010-1328-2

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