Ferrante L, Mastronardi L, Acqui M, Fortuna A
Department of Neurological Sciences, University of Rome La Sapienza, Italy.
J Neurosurg. 1990 Jun;72(6):959-63. doi: 10.3171/jns.1990.72.6.0959.
Three patients aged 5 1/2 to 9 years old with mutism after posterior fossa surgery are presented. The entity is discussed with a review of 15 additional previously reported cases in children aged 2 to 11 years. In all 18 patients, a large midline tumor of the posterior fossa (medulloblastoma in nine cases, astrocytoma in five, and ependymoma in four), often attached to one or both lateral recesses of the fourth ventricle, was removed. Mutism developed 18 to 72 hours after the operation (mean 41.5 hours) in patients with no disturbance of consciousness and no deficits of the lower cranial nerves or of the organs of phonation. All of these children had spoken in the first hours after surgery. The disorder lasted from 3 to 16 weeks (mean 7.9 weeks). Speech was regained after a period of dysarthria in six of the 10 cases for whom this information was available. The various hypotheses advanced to explain the pathogenesis of this speech disorder are analyzed.
本文报告了3例年龄在5岁半至9岁之间，在后颅窝手术后出现缄默症的患者。结合另外15例先前报道的2至11岁儿童病例进行了讨论。在所有18例患者中，均切除了后颅窝的大型中线肿瘤（9例为髓母细胞瘤，5例为星形细胞瘤，4例为室管膜瘤），这些肿瘤通常附着于第四脑室的一个或两个侧隐窝。在意识无紊乱、下颅神经及发声器官无功能障碍的患者中，术后18至72小时（平均41.5小时）出现缄默症。所有这些儿童在术后最初几小时均能说话。这种障碍持续3至16周（平均7.9周）。在可获得此信息的10例患者中，有6例在经历一段构音障碍期后恢复了言语能力。分析了为解释这种言语障碍的发病机制而提出的各种假说。
