Cerebellar mutism

A review

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  • Department of Pediatric Neurosurgery, Mitera Children's Hospital, Athens, Greece
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Mutism of cerebellar origin is a well-described clinical entity that complicates operations for posterior fossa tumors, especially in children. This review focuses on the current understanding of principal pathophysiological aspects and risk factors, epidemiology, clinical characteristics, treatment strategies, and outcome considerations. The PubMed database was searched using the term cerebellar mutism and relevant definitions to identify publications in the English-language literature. Pertinent publications were selected from the reference lists of the previously identified articles. Over the last few years an increasing number of prospective studies and reviews have provided valuable information regarding the cerebellar mutism syndrome. Importantly, the clarification of principal terminology that surrounds the wide clinical spectrum of the syndrome results in more focused research and more effective identification of this entity. In children who undergo surgery for medulloblastoma the incidence of cerebellar mutism syndrome was reported to be 24%, and significant risk factors so far are brainstem involvement and midline location of the tumor. The dentate-thalamo-cortical tracts and lesions that affect their integrity are considered significant pathophysiological issues, especially the tract that originates in the right cerebellar hemisphere. Moderate and severe forms of the cerebellar mutism syndrome are the most frequent types during the initial presentation, and the overall neurocognitive outcome is not as favorable as thought in the earlier publications. Advanced neuroimaging techniques could contribute to identification of high-risk patients preoperatively and allow for more effective surgical planning that should focus on maximal tumor resection with minimal risk to important neural structures. Properly designed multicenter trials are needed to provide stronger evidence regarding effective prevention of cerebellar mutism and the best therapeutic approaches for such patients with a combination of pharmacological agents and multidisciplinary speech and behavior augmentation.

Abbreviations used in this paper:

CM = cerebellar mutism; CMS = CM syndrome; DTC = dentato-thalamo-cortical; DTI = diffusion tensor imaging; FA = fractional anisotropy; fcMRI = functional connectivity MRI; MSD = mutism and subsequent dysarthria; PFS = posterior fossa syndrome.

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Contributor Notes

Address correspondence to: Vassilios Tsitouras, M.D., Department of Pediatric Neurosurgery, Mitera Children's Hospital, 6 Erythrou Stavrou St., Marousi, Athens 151 23, Greece. email: vatsitouras@yahoo.gr.

Please include this information when citing this paper: published online September 27, 2013; DOI: 10.3171/2013.8.PEDS13168.

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