Gudrunardottir Thora, Morgan Angela T, Lux Andrew L, Walker David A, Walsh Karin S, Wells Elizabeth M, Wisoff Jeffrey H, Juhler Marianne, Schmahmann Jeremy D, Keating Robert F, Catsman-Berrevoets Coriene
Department of Oncology and Palliation, North Zealand Hospital, Dyrehavevej 29, 3400, Hilleroed, Denmark.
Centre for Neuroscience of Speech, University of Melbourne, Melbourne, Australia.
Childs Nerv Syst. 2016 Jul;32(7):1195-203. doi: 10.1007/s00381-016-3093-3. Epub 2016 May 3.
Confusion has surrounded the description of post-operative mutism and associated morbidity in pediatric patients with cerebellar tumors for years. The heterogeneity of definitions and diagnostic features has hampered research progress within the field, and to date, no international guidelines exist on diagnosis, prevention, treatment, or follow-up of this debilitating condition. An international group of clinicians and researchers from multiple relevant disciplines recently formed a cohesive panel to formulate a new working definition and agree upon standardized methods for diagnosis and follow-up.
Consensus was obtained using the modified nominal group technique, involving four rounds of online Delphi questionnaires interspersed with a structured consensus conference with lectures, group work, and open discussion sessions.
A new, proposed definition of "post-operative pediatric CMS" was formed, preliminary recommendations for diagnostic and follow-up procedures were created, two working groups on a new scoring scale and risk prediction and prevention were established, and areas were identified where further information is needed.
The consensus process was motivated by desire to further research and improve quality of life for pediatric brain tumor patients. The Delphi rounds identified relevant topics and established basic agreement, while face-to-face engagement helped resolve matters of conflict and refine terminology. The new definition is intended to provide a more solid foundation for future clinical and research work. It is thought as a consensus for moving forward and hopefully paves the way to developing a standard approach to this challenging problem with the advent of better scoring methods and ultimate goal of reducing the risk of CMS.
多年来，小儿小脑肿瘤患者术后缄默症及其相关发病率的描述一直存在混淆。定义和诊断特征的异质性阻碍了该领域的研究进展，迄今为止，对于这种使人衰弱的病症，在诊断、预防、治疗或随访方面尚无国际指南。最近，来自多个相关学科的一组国际临床医生和研究人员组成了一个有凝聚力的小组，以制定新的工作定义，并就诊断和随访的标准化方法达成一致。
采用改良的名义小组技术达成共识，包括四轮在线德尔菲问卷，其间穿插有结构化的共识会议，会议包含讲座、小组工作和开放讨论环节。
形成了一个新的、提议的“小儿术后缄默症（CMS）”定义，制定了诊断和随访程序的初步建议，成立了两个关于新评分量表以及风险预测与预防的工作组，并确定了需要进一步信息的领域。
达成共识的过程是出于进一步研究并改善小儿脑肿瘤患者生活质量的愿望。德尔菲轮次确定了相关主题并达成了基本共识，而面对面的交流有助于解决冲突问题并完善术语。新定义旨在为未来的临床和研究工作提供更坚实的基础。它被视为向前推进的共识，有望随着更好评分方法的出现以及降低CMS风险这一最终目标的实现，为解决这一具有挑战性的问题开辟一条标准化途径。
