McMillan H J, Keene D L, Matzinger M A, Vassilyadi M, Nzau M, Ventureyra E C G
Division of Neurology, Children's Hospital of Eastern Ontario, ON, Canada.
Childs Nerv Syst. 2009 Jun;25(6):677-81. doi: 10.1007/s00381-008-0777-3. Epub 2008 Dec 12.
Cerebellar mutism is a common complication of posterior fossa tumor resection. We observed marked, preoperative brainstem compression on MR imaging, among patients who developed postoperative mutism. This study was designed to investigate if an association was indeed present.
Patients (18 months-18 years) undergoing resection of a midline, posterior fossa tumor were retrospectively reviewed. Demographic data, tumor pathology, mutism onset and duration, and postoperative complications were obtained from hospital records. Pre- and postoperative MR images were studied to assess tumor size and the severity of pons compression (an estimate of the mechanical and distortional forces imparted by the tumor).
Patients with mutism showed greater preoperative pons compression and a greater increase in postoperative pons diameter.
We predict that brainstem compression may represent white-matter injury from (1) surgical manipulation and traction, and (2) axonal damage caused by the release of the tumor's compressive force and ensuing axon distortion and dysfunction. The results provide support that mutism may be largely caused by white-matter damage disrupted axon integrity and function.
小脑缄默症是后颅窝肿瘤切除术后的常见并发症。我们在术后出现缄默症的患者中观察到，术前磁共振成像显示脑干有明显受压。本研究旨在调查两者之间是否确实存在关联。
回顾性分析18个月至18岁接受中线后颅窝肿瘤切除术的患者。从医院记录中获取人口统计学数据、肿瘤病理、缄默症的发作及持续时间以及术后并发症。研究术前和术后的磁共振图像，以评估肿瘤大小和脑桥受压程度（对肿瘤施加的机械力和变形力的估计）。
出现缄默症的患者术前脑桥受压更严重，术后脑桥直径增加幅度更大。
我们推测脑干受压可能代表（1）手术操作和牵拉导致的白质损伤，以及（2）肿瘤压迫力解除后引起的轴突损伤，继而导致轴突扭曲和功能障碍。研究结果支持缄默症可能主要由破坏轴突完整性和功能的白质损伤所致。
