D'Amico Alberto, Sala Francesco
Section of Neurosurgery, Department of Neurosciences, Biomedicine and Movement Sciences, University Hospital, Piazzale Stefani 1, 37124, Verona, Italy.
Childs Nerv Syst. 2020 Jun;36(6):1181-1186. doi: 10.1007/s00381-020-04565-y. Epub 2020 Apr 3.
Cerebellar mutism (CM) is a condition that occurs predominantly in children, after posterior fossa surgery (PFS). It is characterized by motor, speech, and behavioral disorders. Despite widespread use of intraoperative neurophysiological monitoring (IONM), little is known about the neurophysiological aspects involved in the pathophysiology of CM. We reviewed the IONM literature to identify working hypotheses aimed to investigate intraoperatively the circuits involved in CM.
A systematic review of the literature was conducted using PubMed central database. Papers describing the use of IONM techniques in the cerebellum were selected, thoroughly reviewed, and discussed.
Only two studies reported the use of intraoperative neurophysiology of the cerebellum, suggesting a possible somatotopic motor organization of the cerebellar cortex. In addition, extra-operative studies using transcranial magnetic stimulation showed the possibility to modulate-possibly through the dentato-thalamic-cortical (DTC) pathway-primary motor cortex output using an appropriate cerebellar stimulus. In theory, the preservation of this either inhibitory or facilitatory modulation may predict the preservation of this pathway, while a loss of the effect may indicate an injury to the pathway, and predict a CM. Analogously, in the extra-operative setting, the comparison of pre-operative and post-operative transcranial magnetic stimulation of the cerebellum may predict the onset of CM whenever a pre-existing modulatory effect is lost as a result of surgery.
Virtually, no data exist on the intraoperative neurophysiology of the cerebellum. This limited knowledge, nevertheless, offers a unique opportunity to pediatric neurosurgeons to develop and test working hypotheses on the pathophysiology of CM, through the use of IONM.
小脑缄默症（CM）主要发生于儿童后颅窝手术后（PFS）。其特征为运动、言语及行为障碍。尽管术中神经生理监测（IONM）已广泛应用，但对CM病理生理学所涉及的神经生理方面仍知之甚少。我们回顾了IONM相关文献，以确定旨在术中研究CM所涉及神经回路的可行假设。
使用PubMed中央数据库对文献进行系统回顾。选取并详细回顾及讨论了描述IONM技术在小脑中应用的论文。
仅有两项研究报道了小脑术中神经生理学情况，提示小脑皮质可能存在躯体运动定位组织。此外，经颅磁刺激的术后研究表明，使用适当的小脑刺激可能通过齿状核 - 丘脑 - 皮质（DTC）通路调节初级运动皮质输出。理论上，这种抑制性或易化性调节的保留可能预示该通路的保留，而效应丧失可能表明该通路受损，并预示会发生CM。类似地，在术后情况下，当手术导致术前存在的调节效应丧失时，术前和术后小脑经颅磁刺激的比较可能预示CM的发生。
实际上，关于小脑术中神经生理学的数据几乎不存在。然而，这一有限的知识为小儿神经外科医生提供了一个独特的机会，可通过使用IONM来制定和测试关于CM病理生理学的可行假设。
