Artikel
Fronto-cerebellar tractography in patients following cerebellar tumor removal – correlation with posterior fossa syndrom
Suche in Medline nach
Autoren
Veröffentlicht: | 20. Mai 2009 |
---|
Gliederung
Text
Objective: Cerebellar mutism syndrome (CMS) is a dreaded complication following fossa posterior tumor removal in children and is characterized by an inhibition of neuropsychological impulsion. Similar symptoms can also be observed after extensive bifrontal lobe disturbances. We hypothesize that disruption of fronto-cerebellar association fibres (FCF) may be involved to cause the manifestation of this syndrome.
Methods: In 29 patients (mean age: 8.9±4.4 years), who received posterior fossa tumor removal (pilocytic astrocytoma [n=14], medulloblastoma [n=13], ependymoma [n=2]) as well as in 10 healthy children (12.9±3.8 years), diffusion weighted imaging (3Tesla MRI, Signa, GE) was performed to generate tractography of FCF using a fiber tracking algorithm software (brainLab 2.5). The volume of these fibre tracts was measured in each patient. On reconstructed slices the anatomical course of the fibres were determined and measured in a semiquantitative manner. In addition postoperative clinical symptoms of CMS were recorded.
Results: The pathway of FCF could be visualized bilaterally in each patient. In volume measurements of FCF a significant difference between children with symptoms of CMS (19.3±11.7 cm3) could be observed compared to neurological unaffected children (26.9±11.9 cm3) and to control group (36.5±13.82 cm3). In the semi-quantitative analysis of anatomical structures significant differences of the fibre tract visualization was observed in the superior cerebellar peduncle and the midline cerebellar structures comparing CMS with less distinct tracts compared to neurological unaffected children as well as compared to controls (p<0.01). Similar differences were found in the same structures looking at medulloblastoma compared to pilocytic astrocytoma patients as well as the control group (p<0.05).
Conclusions: DTI is a feasible method for visualizing fronto-cerebellar fiberes. Our data identifies the involvement of postoperative disturbed FCF tracts at the location of the superior cerebellar peduncle and midline cerebellar structures to contribute to CMS.