Cerebellar mutism: the predictive role of preoperative language evaluation
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.
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.
KeywordsPosterior fossa tumor Medulloblastoma Cerebellar mutism Preoperative language impairment
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 3.Di Rocco C, Chieffo D, Pettorini BL et al (2010) Preoperative and postoperative neurological, neuropsychological and behavioral impairment in children with posterior cranial fossa astrocytomas and medulloblastomas: the role of the tumor and the impact of the surgical treatment. Chils Nerv Syst 26:1173–1188. https://doi.org/10.1007/s00381-010-1166-2 CrossRefGoogle Scholar
- 7.Wibroe M, Cappelen J, Castor C, Clausen N, Grillner P, Gudrunardottir T, Gupta R, Gustavsson B, Heyman M, Holm S, Karppinen A, Klausen C, Lönnqvist T, Mathiasen R, Nilsson P, Nysom K, Persson K, Rask O, Schmiegelow K, Sehested A, Thomassen H, Tonning-Olsson I, Zetterqvist B, Juhler M (2017) Cerebellar mutism syndrome in children with brain tumours of the posterior fossa. BMC Cancer 17:439. https://doi.org/10.1186/s12885-017-3416-0 CrossRefGoogle Scholar
- 12.Palmer SL, Hassall T, Evankovich K, Mabbott DJ, Bonner M, Deluca C, Cohn R, Fisher MJ, Morris EB, Broniscer A, Gajjar A (2010) Neurocognitive outcome 12 months following cerebellar mutism syndrome in pediatric patients with medulloblastoma. Neuro-Oncol 12:1311–1317. https://doi.org/10.1093/neuonc/noq094 Google Scholar