gms | German Medical Science

73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

29.05. - 01.06.2022, Köln

Cerebellar mutism following posterior fossa surgery in children – what we have learnt over the last 10 years

Zerebellärer Mutismus nach Resektionen in der hinteren Schädelgrube bei Kindern, unsere Erfahrung über die letzten 10 Jahre

Meeting Abstract

  • presenting/speaker Stephanie Schmidt - Universitätsklinikum Heidelberg, Neurochirurgische Klinik, Heidelberg, Deutschland
  • Edina Kovacs - Universitätsklinikum Heidelberg, Neurochirurgische Klinik, Heidelberg, Deutschland
  • Felix Sahm - Universitätsklinikum Heidelberg, Pathologisches Institut, Abteilung Neuropathologie, Heidelberg, Deutschland
  • Daniel Haux - Universitätsklinikum Heidelberg, Neurochirurgische Klinik, Heidelberg, Deutschland
  • Till Milde - Universitätsklinikum Heidelberg, Pädiatrische Onkologie, Heidelberg, Deutschland
  • Andreas W. Unterberg - Universitätsklinikum Heidelberg, Neurochirurgische Klinik, Heidelberg, Deutschland
  • Ahmed El Damaty - Universitätsklinikum Heidelberg, Neurochirurgische Klinik, Heidelberg, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie. Köln, 29.05.-01.06.2022. Düsseldorf: German Medical Science GMS Publishing House; 2022. DocP186

doi: 10.3205/22dgnc501, urn:nbn:de:0183-22dgnc5017

Published: May 25, 2022

© 2022 Schmidt et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Objective: The aim is to present our institutional experience with resection of posterior fossa tumors in children with focus on the incidence of cerebellar mutism syndrome (CMS) postoperatively and to analyze its association with multiple risk factors, such as tumor entity, size and location, surgical approach, usage of ultrasonic cavitation device and hydrocephalus.

Methods: All pediatric patients, who received a tumor resection in the posterior fossa between January 2010 and March 2021 were included for retrospective analysis. Various data points, including demographic, tumor-associated, clinical, radiological, surgery-associated, complications and follow-up data were collected and statistically evaluated for association with CMS.

Results: 60 patients were included with a median age of 7,5 years (range 0-18). Integrated histopathology showed 26 pilocytic astrocytomas (43%), 18 medulloblastomas (29%) 6 anaplastic ependymomas (9%) and 10 other tumor entities (17%). Average tumor volume was 29 (+/-25.2) cm3. Complete resection was achieved in 40 patients (67%), 14 patients (23%) underwent subtotal resection and 6 patients (10 %) underwent partial resection. 28 patients (47%) were operated using a telovelar approach, 5 (8%) using a transvermian approach and 29 (48%) using other approaches such as transcerebellar, retrosigmoidal or supracerebellar. 10 patients (17%) developed CMS postoperatively, of which 4 out of 28 patients (14%) were operated using a telovelar approach compared to 3 out of 5 patients (60%) with a transvermian approach. 6 out of 10 patients with CMS were diagnosed with medulloblastoma, 3 with pilocytic astrocytoma and one with anaplastic ependymoma. All patients with CMS showed marked improvement but with residual neurological symptoms in their follow-up. 43 patients (72%) presented with hydrocephalus preoperatively, of which 21 patients (35%) required implantation of a ventriculo-peritoneal shunt.

Conclusion: CMS was often seen after tumor resection via transvermian approach. Telovelar approach seems to be safer but still carries the risk of development of CMS after surgery but to a lesser extent. Incidence of CMS in our cohort is comparable with the incidence reported in literature between 10-20%. High grade of malignancy as in medulloblastomas is associated with higher incidence of CMS.