Riggs Lily, Bouffet Eric, Laughlin Suzanne, Laperriere Normand, Liu Fang, Skocic Jovanka, Scantlebury Nadia, Wang Frank, Schoenhoff Nicholas J, Strother Douglas, Hukin Juliette, Fryer Christopher, McConnell Dina, Mabbott Donald J
1 Neurosciences and Mental Health, Hospital for Sick Children, Toronto, Ontario.
3 Department of Haematology/Oncology, Hospital for Sick Children, Toronto, Ontario.
J Int Neuropsychol Soc. 2014 Feb;20(2):168-80. doi: 10.1017/S135561771300129X. Epub 2014 Jan 24.
Children treated for medulloblastoma (MB) exhibit long-term impairments in declarative memory, but the pathophysiology underlying this is unclear. Previous studies report declines in global white matter volume, but have failed to link this to declines in memory performance. We examined the effects of treatment on measures of global brain structure (i.e., total white and gray matter volume) and specific memory structures (i.e., hippocampus and uncinate fasciculus). We used volumetric MRI and diffusion tensor imaging in pediatric survivors of MB and one survivor of astrocytoma treated with cranial-spinal radiation (n = 20), and healthy controls (n = 13). Compared to controls, the survivor group exhibited reduced white matter volume, damage to the uncinate fasciculus, and a smaller right hippocampus. Critically, reduced hippocampal volume was not related to differences in brain volume, suggesting that the hippocampus may be especially vulnerable to treatment effects. A subset of the survivors (n = 10) also underwent memory testing using the Children's Memory Scale (CMS). Performance on the general index of the CMS was significantly correlated with measures of hippocampal volume and uncinate fasciculus. The examination of treatment effects on specific brain regions provides a better understanding of long-term cognitive outcome in children with brain tumors, particularly medulloblastoma.
接受髓母细胞瘤（MB）治疗的儿童在陈述性记忆方面存在长期损伤，但其潜在的病理生理学尚不清楚。先前的研究报告了全脑白质体积的下降，但未能将其与记忆表现的下降联系起来。我们研究了治疗对全脑结构指标（即白质和灰质总体积）和特定记忆结构（即海马体和钩束）的影响。我们对接受颅脊髓放疗的MB儿科幸存者和一名星形细胞瘤幸存者（n = 20）以及健康对照者（n = 13）进行了容积磁共振成像和扩散张量成像。与对照组相比，幸存者组的白质体积减少，钩束受损，右侧海马体较小。至关重要的是，海马体体积减小与脑体积差异无关，这表明海马体可能特别容易受到治疗影响。一部分幸存者（n = 10）还使用儿童记忆量表（CMS）进行了记忆测试。CMS总体指数的表现与海马体体积和钩束的测量值显著相关。对特定脑区治疗效果的研究有助于更好地理解脑肿瘤儿童，尤其是髓母细胞瘤儿童的长期认知结果。
