Association between postoperative DTI metrics and neurological deficits after posterior fossa tumor resection in children

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OBJECTIVE

Resection of posterior fossa tumors in children may be associated with persistent neurological deficits. It is unclear if these neurological deficits are associated with persistent structural damage to the cerebellar pathways. The purpose of this research was to define longitudinal changes in diffusion tensor imaging (DTI) metrics in white matter cerebellar tracts and the clinical correlates of these metrics in children undergoing resection of posterior fossa tumors.

METHODS

Longitudinal brain DTI was performed in a cohort of pediatric patients who underwent resection of posterior fossa tumors. Fractional anisotropy (FA) of the superior cerebellar peduncles (SCPs) and middle cerebellar peduncles (MCPs) was measured on preoperative, postoperative, and follow-up DTI. Early postoperative (< 48 hours) and longer-term follow-up neurological deficits (mutism, ataxia, and extraocular movement dysfunction) were documented. Statistical analysis was performed to determine differences in FA values based on presence or absence of neurological deficits. Statistical significance was set at p < 0.05.

RESULTS

Twenty children (mean age 6.1 ± 4.1 years [SD], 12 males and 8 females) were included in this study. Follow-up DTI was performed at a median duration of 14.3 months after surgery, and the median duration of follow-up was 19.7 months. FA of the left SCP was significantly reduced on postoperative DTI in comparison with preoperative DTI (0.44 ± 0.07 vs 0.53 ± 0.1, p = 0.003). Presence of ataxia at follow-up was associated with a persistent reduction in the left SCP FA on follow-up DTI (0.43 ± 0.1 vs 0.55 ± 0.1, p = 0.016). Patients with early postoperative mutism who did not recover at follow-up had significantly decreased FA of the left SCP on early postoperative DTI in comparison with those who recovered (0.38 ± 0.05 vs 0.48 ± 0.06, p = 0.04).

CONCLUSIONS

DTI after resection of posterior fossa tumors in children shows that persistent reduction of SCP FA is associated with ataxia at follow-up.

ABBREVIATIONS FA = fractional anisotropy; DTI = diffusion tensor imaging; MCP = middle cerebellar peduncle; ROI = region of interest; SCP = superior cerebellar peduncle.
Article Information

Contributor Notes

Correspondence Sandi K. Lam: Texas Children’s Hospital, Baylor College of Medicine, Houston, TX. sklam@texaschildrens.org.INCLUDE WHEN CITING Published online July 19, 2019; DOI: 10.3171/2019.5.PEDS1912.Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

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References
  • 1

    Aarsen FKVan Dongen HRPaquier PFVan Mourik MCatsman-Berrevoets CE: Long-term sequelae in children after cerebellar astrocytoma surgery. Neurology 62:131113162004

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2

    Aguiar PHPlese JPCiquini OMarino R: Transient mutism following a posterior fossa approach to cerebellar tumors in children: a critical review of the literature. Childs Nerv Syst 11:3063101995

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3

    Avula SKumar RPizer BPettorini BAbernethy LGarlick D: Diffusion abnormalities on intraoperative magnetic resonance imaging as an early predictor for the risk of posterior fossa syndrome. Neuro Oncol 17:6146222015

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4

    Buzunov EOjemann JGRobinson FR: Rhesus macaque as an animal model for posterior fossa syndrome following tumor resection. Pediatr Neurosurg 46:1201262010

  • 5

    Catsman-Berrevoets CEVan Dongen HRMulder PGPaz y Geuze DPaquier PFLequin MH: Tumour type and size are high risk factors for the syndrome of “cerebellar” mutism and subsequent dysarthria. J Neurol Neurosurg Psychiatry 67:7557571999

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6

    Cochrane DDGustavsson BPoskitt KPSteinbok PKestle JR: The surgical and natural morbidity of aggressive resection for posterior fossa tumors in childhood. Pediatr Neurosurg 20:19291994

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7

    Dailey ATMcKhann GM IIBerger MS: The pathophysiology of oral pharyngeal apraxia and mutism following posterior fossa tumor resection in children. J Neurosurg 83:4674751995

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8

    Della Nave RGinestroni ATessa CSalvatore EBartolomei ISalvi F: Brain white matter tracts degeneration in Friedreich ataxia. An in vivo MRI study using tract-based spatial statistics and voxel-based morphometry. Neuroimage 40:19252008

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 9

    Gadgil NHansen DBarry JChang RLam S: Posterior fossa syndrome in children following tumor resection: Knowledge update. Surg Neurol Int 7 (Suppl 6):S179S1832016

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 10

    Habas CCabanis EA: Anatomical parcellation of the brainstem and cerebellar white matter: a preliminary probabilistic tractography study at 3 T. Neuroradiology 49:8498632007

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 11

    Hong JHKim OLKim SHLee MYJang SH: Cerebellar peduncle injury in patients with ataxia following diffuse axonal injury. Brain Res Bull 80:30352009

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    Kusano YTanaka YTakasuna HWada NTada TKakizawa Y: Transient cerebellar mutism caused by bilateral damage to the dentate nuclei after the second posterior fossa surgery. Case report. J Neurosurg 104:3293312006

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13

    Kwon HGHong JHHong CPLee DHAhn SHJang SH: Dentatorubrothalamic tract in human brain: diffusion tensor tractography study. Neuroradiology 53:7877912011

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14

    McEvoy SDLee APoliakov AFriedman SShaw DBrowd SR: Longitudinal cerebellar diffusion tensor imaging changes in posterior fossa syndrome. Neuroimage Clin 12:5825902016

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15

    Morris EBPhillips NSLaningham FHPatay ZGajjar AWallace D: Proximal dentatothalamocortical tract involvement in posterior fossa syndrome. Brain 132:308730952009

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16

    Oh MEDriever PHKhajuria RKRueckriegel SMKoustenis EBruhn H: DTI fiber tractography of cerebro-cerebellar pathways and clinical evaluation of ataxia in childhood posterior fossa tumor survivors. J Neurooncol 131:2672762017

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17

    Ojemann JGPartridge SCPoliakov AVNiazi TNShaw DWIshak GE: Diffusion tensor imaging of the superior cerebellar peduncle identifies patients with posterior fossa syndrome. Childs Nerv Syst 29:207120772013

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18

    Patay Z: Postoperative posterior fossa syndrome: unraveling the etiology and underlying pathophysiology by using magnetic resonance imaging. Childs Nerv Syst 31:185318582015

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19

    Piscione PJBouffet EMabbott DJShams IKulkarni AV: Physical functioning in pediatric survivors of childhood posterior fossa brain tumors. Neuro Oncol 16:1471552014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20

    Polders DLLeemans AHendrikse JDonahue MJLuijten PRHoogduin JM: Signal to noise ratio and uncertainty in diffusion tensor imaging at 1.5, 3.0, and 7.0 Tesla. J Magn Reson Imaging 33:145614632011

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21

    Pollack IF: Posterior fossa syndrome. Int Rev Neurobiol 41:4114321997

  • 22

    Riva DGiorgi C: The cerebellum contributes to higher functions during development: evidence from a series of children surgically treated for posterior fossa tumours. Brain 123:105110612000

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23

    Soelva VHernáiz Driever PAbbushi ARueckriegel SBruhn HEisner W: Fronto-cerebellar fiber tractography in pediatric patients following posterior fossa tumor surgery. Childs Nerv Syst 29:5976072013

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24

    Steinbok PMangat JSKerr JMSargent MSuryaningtyas WSinghal A: Neurological morbidity of surgical resection of pediatric cerebellar astrocytomas. Childs Nerv Syst 29:126912752013

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25

    Vavasour IMMeyers SMMädler BHarris TFu ELi DKB: Multicenter measurements of T1 relaxation and diffusion tensor imaging: intra and intersite reproducibility. J Neuroimaging 29:42512019

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26

    Vedantam AJirjis MBSchmit BDWang MCUlmer JLKurpad SN: Diffusion tensor imaging of the spinal cord: insights from animal and human studies. Neurosurgery 74:182014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27

    Vollmar CO’Muircheartaigh JBarker GJSymms MRThompson PKumari V: Identical, but not the same: intra-site and inter-site reproducibility of fractional anisotropy measures on two 3.0T scanners. Neuroimage 51:138413942010

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28

    Zhou XSakaie KEDebbins JPNarayanan SFox RJLowe MJ: Scan-rescan repeatability and cross-scanner comparability of DTI metrics in healthy subjects in the SPRINT-MS multicenter trial. Magn Reson Imaging 53:1051112018

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
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