Department of neurosurgery, SMS Medical College and Hospital, Jaipur, Rajasthan, India.
Acta Neurochir Suppl. 2023;135:53-59. doi: 10.1007/978-3-031-36084-8_10.
Cerebellar mutism syndrome (CMS) is a morbid complication of posterior fossa surgery in children. This review focuses on the current understanding of pathophysiology in the white matter tracts (WMT) using diffusion tensor imaging (DTI).
A series of 38 patients operated on for posterior fossa tumors in our institute between December 2019 till May 2021 were evaluated neurologically along with characteristics of mutism and DTI imaging (fractional anisotropy) in preoperative and postoperative periods. We also noted tumor size, location, volume, brainstem compression, cerebellar peduncle involvement, extent of resection, surgical approach, and histopathology.
Cerebellar mutism developed in five patients. The mean age, male sex, tumor size >5 cm, superior cerebellar peduncle involvement, and vermian incision were found to have positive correlation with the development of CMS. They showed reduction in fractional anisotropy in superior cerebellar peduncle (SCP) following resection; however, others' WMT did not show any significant change in fractional anisotropy values pre- or post-surgery.
Our study suggests that functional disruption of WMT, i.e., superior cerebellar peduncle and dentato-thalamo-cortical tract (DTC) is the underlying pathophysiological component of CMS. Taking this into consideration, we need to deploy techniques to limit the damage to the superior cerebellar peduncle and DTC using neurophysiological monitoring.
小脑缄默症（CMS）是儿童后颅窝手术的一种严重并发症。本综述重点关注使用弥散张量成像（DTI）在后颅窝肿瘤患儿中对脑白质束（WMT）的病理生理学的当前认识。
对 2019 年 12 月至 2021 年 5 月期间在我院接受后颅窝肿瘤手术的 38 例患者进行了神经学评估，并对其缄默症特征和术前及术后的 DTI 成像（各向异性分数）进行了评估。我们还记录了肿瘤的大小、位置、体积、脑干受压、小脑脚受累、切除范围、手术入路和组织病理学。
5 例患者出现小脑缄默症。平均年龄、男性、肿瘤大小＞5cm、上小脑脚受累和蚓部切口与 CMS 的发生呈正相关。他们在切除后上小脑脚（SCP）的各向异性分数减少；然而，其他人的 WMT 在手术前后的各向异性分数值没有明显变化。
我们的研究表明，WMT 功能障碍，即上小脑脚和齿状核-丘脑-皮质束（DTC）的功能障碍是 CMS 的潜在病理生理学组成部分。考虑到这一点，我们需要使用神经生理监测技术来限制对上小脑脚和 DTC 的损伤。
