Bhattacharya Kajari, Rai Pranjal, Moiyadi Aliasgar, Sahu Arpita, Gupta Tejpal, Chinnaswamy Girish, Shetty Prakash, Choudhari Amit, Guha Amrita, Chatterjee Abhishek, Dasgupta Archya, Shetty Nitin, Kulkarni Suyash
Department of Radiology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India.
Department of Radiology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India.
World Neurosurg. 2025 Jan;193:567-576. doi: 10.1016/j.wneu.2024.10.043. Epub 2024 Nov 9.
Hypertrophic olivary degeneration (HOD) is a rare form of transsynaptic degeneration, caused by injury to the dentato-rubro-olivary pathway (DROP). Radiologically, this manifests as T2 hyperintensity, with or without enlargement of the inferior olivary nucleus. The purpose of the study was to evaluate the incidence, associated imaging characteristics, potential etiologies, latency period, and temporal progression of HOD in patients undergoing surgical resection of posterior fossa tumors (PFTs).
A retrospective analysis of patients with PFTs and postsurgical magnetic resonance imaging scans was conducted. HOD was diagnosed based on inferior olivary nucleus signal abnormalities and size changes. Demographics, tumor characteristics, time to HOD onset, involved DROP components, and clinical symptoms were recorded.
HOD was seen in 40 (6.2%) patients following PFT surgery. Twenty six patients were aged 17 years or less, while the rest were aged more than 17 years. Medulloblastoma was the most frequently diagnosed tumor type (n = 25), followed by pilocytic astrocytoma (n = 8), ependymoma (n = 6), and high-grade glioma (n = 1). No statistical association was found between the development of HOD and tumor grade (P = 0.882). Ataxia was the most commonly reported clinical symptom (n = 15). The time elapsed between surgery and the diagnosis of HOD varied, with median intervals of 1 month, 5 months, and 37 months for different stages. Dentate nucleus was the most commonly affected component of the DROP (n = 36).
HOD is a frequently overlooked postoperative complication following PFT resection. Increased recognition of HOD by neuroradiologists is essential for timely diagnosis and avoidance of unnecessary diagnostic procedures.
肥大性橄榄核变性（HOD）是一种罕见的跨突触变性形式，由齿状红核橄榄束通路（DROP）损伤引起。在影像学上，其表现为T2高信号，伴或不伴有下橄榄核增大。本研究的目的是评估后颅窝肿瘤（PFT）手术切除患者中HOD的发生率、相关影像学特征、潜在病因、潜伏期及时间进展情况。
对PFT患者及术后磁共振成像扫描进行回顾性分析。根据下橄榄核信号异常和大小变化诊断HOD。记录人口统计学资料、肿瘤特征、HOD发病时间、受累的DROP组成部分及临床症状。
40例（6.2%）PFT手术后患者出现HOD。26例患者年龄在17岁及以下，其余患者年龄超过17岁。髓母细胞瘤是最常诊断出的肿瘤类型（n = 25），其次是毛细胞型星形细胞瘤（n = 8）、室管膜瘤（n = 6）和高级别胶质瘤（n = 1）。未发现HOD的发生与肿瘤分级之间存在统计学关联（P = 0.882）。共济失调是最常报告的临床症状（n = 15）。手术与HOD诊断之间的时间间隔各不相同，不同阶段的中位间隔分别为1个月、5个月和37个月。齿状核是DROP中最常受累的组成部分（n = 36）。
HOD是PFT切除术后一种常被忽视的术后并发症。神经放射科医生提高对HOD的认识对于及时诊断和避免不必要的诊断程序至关重要。
