Department of Neurology, University of Duisburg-Essen, Hufelandstr. 55, 45122, Essen, Germany.
Cerebellum. 2013 Feb;12(1):48-58. doi: 10.1007/s12311-012-0389-z.
Sequelae in children following cerebellar tumor removal surgery are well defined, and predictors for poor recovery include lesions of the cerebellar nuclei and the inferior vermis. Dynamic reorganization is thought to promote functional recovery in particular within the first year after surgery. Yet, the time course and mechanisms of recovery within this critical time frame are elusive and longitudinal studies are missing. Thus, a group of children and adolescents (n = 12, range 6-17 years) were followed longitudinally after cerebellar surgery and compared to age- and gender-matched controls (n = 11). Patients were examined (1) within the first days, (2) 3 months, and (3) 1 year after surgery. Each time behavioral tests of balance and upper limb motor function, ataxia rating, and a MRI scan were performed. Data were used for subsequent lesion-symptom mapping of cerebellar function. Behavioral improvements continued beyond 3 months, but were not complete in all patients after 1 year. At that time, remaining deficits were mild. Within the first 3 months, cerebellar lesion volumes were notably reduced by vanishing edema. Reduction in edema affecting the deep cerebellar nuclei but not reduction of total cerebellar lesion volume was a major predictor of early functional recovery. Persistent impairment in balance and upper limb function was linked to permanent lesions of the inferior vermis and the deep cerebellar nuclei.
儿童小脑肿瘤切除术后的后遗症是明确的，预测恢复不良的因素包括小脑核和下蚓部的病变。动态重组被认为可以促进手术后第一年的功能恢复。然而，在这个关键时期内，恢复的时间进程和机制仍不清楚，并且缺乏纵向研究。因此，一组儿童和青少年（n=12，年龄范围为 6-17 岁）在小脑手术后进行了纵向随访，并与年龄和性别匹配的对照组（n=11）进行了比较。患者在手术后（1）最初几天、（2）3 个月和（3）1 年内接受了检查。每次检查均进行了平衡和上肢运动功能的行为测试、共济失调评分和 MRI 扫描。数据用于随后进行小脑功能的病变-症状映射。行为改善持续超过 3 个月，但在 1 年后并非所有患者都完全恢复。此时，剩余的缺陷是轻微的。在最初的 3 个月内，由于水肿消失，小脑病变体积明显减少。影响深部小脑核的水肿减少，而不是总小脑病变体积的减少，是早期功能恢复的主要预测因素。平衡和上肢功能的持续障碍与下蚓部和深部小脑核的永久性病变有关。
