Sergeant Anjali, Kameda-Smith Michelle Masayo, Manoranjan Branavan, Karmur Brij, Duckworth JoAnn, Petrelli Tina, Savage Katey, Ajani Olufemi, Yarascavitch Blake, Samaan M Constantine, Scheinemann Katrin, Alyman Cheryl, Almenawer Saleh, Farrokhyar Forough, Fleming Adam J, Singh Sheila Kumari, Stein Nina
McMaster Pediatric Brain Tumor Study Group, McMaster University, Hamilton, Canada.
Department of Surgery, Division of Neurosurgery, McMaster University, Hamilton, Canada.
J Neurooncol. 2017 Jul;133(3):539-552. doi: 10.1007/s11060-017-2462-4. Epub 2017 May 19.
The surgical risk factors and neuro-imaging characteristics associated with cerebellar mutism (CM) remain unclear and require further investigation. Therefore, we aimed to examine surgical and MRI findings associated with CM in children following posterior fossa tumor resection. Using our data registry, we retrospectively collected data from pediatric patients who acquired CM and were matched based on age and pathology type with individuals who did not acquire CM after posterior fossa surgery. The strength of association between surgical and MRI variables and CM were examined using odds ratios (ORs) and corresponding 95% confidence intervals (CIs). A total of 22 patients (11 with and 11 without CM) were included. Medulloblastoma was the most common pathology among CM patients (91%); the remaining 9% were diagnosed with a pilocytic astrocytoma. Tumor attachment to the floor of the fourth ventricle (OR 6; 95% CI 0.7-276), calcification/hemosiderin deposition (OR 7; 95% CI 0.9-315.5), and post-operative peri-ventricular ischemia on MRI (OR 5; 95% CI 0.5-236.5) were found to have the highest measures of association with CM. Our results may suggest that tumor attachment to the floor of the fourth ventricle, pathological calcification, and post-operative ischemia have a relatively higher prevalence in patients with CM. Collectively, our work calls for a larger multi-institutional cohort study of CM patients to encourage further investigation of the determinants and management of CM in order to potentially minimize its development and predict onset.
与小脑缄默症（CM）相关的手术风险因素和神经影像学特征仍不明确，需要进一步研究。因此，我们旨在研究后颅窝肿瘤切除术后儿童中与CM相关的手术和MRI表现。利用我们的数据登记系统，我们回顾性收集了发生CM的儿科患者的数据，并根据年龄和病理类型与后颅窝手术后未发生CM的个体进行匹配。使用优势比（OR）和相应的95%置信区间（CI）来检验手术和MRI变量与CM之间的关联强度。共纳入22例患者（11例发生CM，11例未发生CM）。髓母细胞瘤是CM患者中最常见的病理类型（91%）；其余9%被诊断为毛细胞型星形细胞瘤。发现肿瘤附着于第四脑室底部（OR 6；95% CI 0.7 - 276）、钙化/含铁血黄素沉积（OR 7；95% CI 0.9 - 315.5）以及MRI上术后脑室周围缺血（OR 5；95% CI 0.5 - 236.5）与CM的关联度最高。我们的结果可能表明，肿瘤附着于第四脑室底部、病理性钙化和术后缺血在CM患者中相对更为常见。总体而言，我们的工作呼吁对CM患者进行更大规模的多机构队列研究，以鼓励进一步研究CM的决定因素和管理方法，从而有可能尽量减少其发生并预测其发作。
