Lassaletta Alvaro, Bouffet Eric, Mabbott Donald, Kulkarni Abhaya V
Division of Pediatric Neuro-oncology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Division of Psychology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Childs Nerv Syst. 2015 Oct;31(10):1877-90. doi: 10.1007/s00381-015-2829-9. Epub 2015 Sep 9.
Tumors of the posterior fossa (PF) account for up to 60 % of all childhood intracranial tumors. Over the last decades, the mortality rate of children with posterior fossa tumors has gradually decreased. While survival has been the primary objective in most reports, quality of survival increasingly appears to be an important indicator of a successful outcome. Children with a PF tumor can sustain damage to the cerebellum and other brain structures from the tumor itself, concomitant hydrocephalus, the consequences of treatment (surgery, chemotherapy, radiotherapy), or a combination of these factors. Together, these contribute to long-term sequelae in physical functioning, neuropsychological late outcomes (including academic outcome, working memory, perception and estimation of time, and selective attention, long-term neuromotor speech deficits, and executive functioning). Long-term quality of life can also be affected by endocrinological complication or the occurrence of secondary tumors. A significant proportion of survivors of PF tumors require long-term special education services and have reduced rates of high school graduation and employment. Interventions to improve neuropsychological functioning in childhood PF tumor survivors include (1) pharmacological interventions (such as methylphenidate, modafinil, or donepezil), (2) cognitive remediation, and (3) home-based computerized cognitive training. In order to achieve the best possible outcome for survivors, and ultimately minimize long-term complications, new interventions must be developed to prevent and ameliorate the neuro-toxic effects experienced by these children.
后颅窝（PF）肿瘤占儿童颅内肿瘤总数的60%。在过去几十年里，患有后颅窝肿瘤儿童的死亡率逐渐下降。虽然在大多数报告中，生存一直是主要目标，但生存质量越来越成为成功治疗结果的一个重要指标。患有PF肿瘤的儿童可能会因肿瘤本身、并发脑积水、治疗（手术、化疗、放疗）后果或这些因素的综合作用而导致小脑和其他脑结构受损。这些共同导致身体功能方面的长期后遗症、神经心理晚期后果（包括学业成绩、工作记忆、时间感知与估计以及选择性注意、长期神经运动性言语缺陷和执行功能）。长期生活质量也可能受到内分泌并发症或继发性肿瘤发生的影响。相当一部分PF肿瘤幸存者需要长期特殊教育服务，且高中毕业后就业率和就业机会降低。改善儿童PF肿瘤幸存者神经心理功能的干预措施包括：（1）药物干预（如哌甲酯、莫达非尼或多奈哌齐），（2）认知矫正，以及（3）基于家庭的计算机化认知训练。为了使幸存者获得尽可能好的结果，并最终将长期并发症降至最低，必须开发新的干预措施来预防和改善这些儿童所经历的神经毒性作用。
