Artikel
Functional recovery of motor function in children and adolescents after cerebellar tumours
Die Rückbildung motorischer Symptome nach Operationen zerebellärer Tumoren im Kindes- und Jugendalter
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Autoren
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B. Schoch
- Klinik für Neurochirurgie, Universitätsklinikum Essen
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J. Konczak
- Human Sensorimotor Control Laboratory and Department of Neurology, University of Minnesota, Minneapolis, USA
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J. P. Regel
- Klinik für Neurochirurgie, Universitätsklinikum Essen
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O. M. Müller
- Klinik für Neurochirurgie, Universitätsklinikum Essen
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D. Timmann-Braun
- Klinik für Neurologie, Universitätsklinikum Essen
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D. Stolke
- Klinik für Neurochirurgie, Universitätsklinikum Essen
| Veröffentlicht: | 30. Mai 2008 |
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Gliederung
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Objective: Aim of the study was to examine the impact of lesion site, tumour size, age at surgery and adjuvant chemotherapy and / or radiotherapy on balance function in children in chronic state after resection of cerebellar tumours.
Methods: A total of 22 patients in chronic state after cerebellar surgery in childhood or adolescence (mean duration after surgery: 8.2 years) and 14 age-matched healthy subjects participated in the study. Clinical outcome was assessed with the semi-quantitative International Cerebellar Ataxia Rating Scale (ICARS). Postural stability was examined by static and dynamic posturography (six conditions) using the Sensory Organization Test (SOT) of the EquiTest® system. In simple terms, the SOT can be understood as a sophisticated extension of the Romberg test. Lesion site and tumour size were recorded with individual, but spatially normalized MRI of each patient.
Results: Postural sway in EquiTest® was enhanced in 14 patients (64%). when proprioceptive or visual information was absent or lost relevance during specific test conditions. When overlaying the MRI images of those patients that exhibited excessive sway outside the range of the control group, the region with the highest overlap included the fastigial nucleus (NF) followed by the interposed nucleus (NI). Cerebellar cortical areas were less frequent included in the lesion area. In patients with normal posture NF and NI were spared. Age at surgery, the time since surgery or lesion volume were poor predictors of motor recovery.
Subanalysis of the group under the aspect of chemotherapy versus no chemotherapy indicated that the sparing of the deep cerebellar nuclei had the greatest impact on the recovery of balance function too.
Conclusions: The study provides clear evidence that a lesion site including the cerebellar nuclei either caused by the tumour itself or caused by surgical damage has a relevant impact on the recovery of motor function. Whenever possible deep cerebellar nuclei should be spared during cerebellar surgery.
