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.
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.
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).
DTI after resection of posterior fossa tumors in children shows that persistent reduction of SCP FA is associated with ataxia at follow-up.
ABBREVIATIONSFA = fractional anisotropy; DTI = diffusion tensor imaging; MCP = middle cerebellar peduncle; ROI = region of interest; SCP = superior cerebellar peduncle.
AarsenFK, Van DongenHR, PaquierPF, Van MourikM, Catsman-BerrevoetsCE: Long-term sequelae in children after cerebellar astrocytoma surgery. 62:1311–1316, 20041511166710.1212/01.WNL.0000120549.77188.36)| false
AguiarPH, PleseJP, CiquiniO, MarinoR: Transient mutism following a posterior fossa approach to cerebellar tumors in children: a critical review of the literature. 11:306–310, 199510.1007/BF003017667648574)| false
AvulaSKumarRPizerBPettoriniBAbernethyLGarlickD: Diffusion abnormalities on intraoperative magnetic resonance imaging as an early predictor for the risk of posterior fossa syndrome. Neuro Oncol17:614–6222015
AvulaS, KumarR, PizerB, PettoriniB, AbernethyL, GarlickD, : Diffusion abnormalities on intraoperative magnetic resonance imaging as an early predictor for the risk of posterior fossa syndrome. 17:614–622, 201510.1093/neuonc/nou29925319997)| false
Catsman-BerrevoetsCEVan DongenHRMulderPGPaz y GeuzeDPaquierPFLequinMH: Tumour type and size are high risk factors for the syndrome of “cerebellar” mutism and subsequent dysarthria. J Neurol Neurosurg Psychiatry67:755–7571999
Catsman-BerrevoetsCE, Van DongenHR, MulderPG, Paz y GeuzeD, PaquierPF, LequinMH: Tumour type and size are high risk factors for the syndrome of “cerebellar” mutism and subsequent dysarthria. 67:755–757, 199910.1136/jnnp.67.6.75510567492)| false
CochraneDD, GustavssonB, PoskittKP, SteinbokP, KestleJR: The surgical and natural morbidity of aggressive resection for posterior fossa tumors in childhood. 20:19–29, 1994814227810.1159/000120761)| false
DaileyAT, McKhannGMII, BergerMS: The pathophysiology of oral pharyngeal apraxia and mutism following posterior fossa tumor resection in children. 83:467–475, 199510.3171/jns.1995.83.3.04677666224)| false
Della NaveRGinestroniATessaCSalvatoreEBartolomeiISalviF: Brain white matter tracts degeneration in Friedreich ataxia. An in vivo MRI study using tract-based spatial statistics and voxel-based morphometry. Neuroimage40:19–252008
Della NaveR, GinestroniA, TessaC, SalvatoreE, BartolomeiI, SalviF, : Brain white matter tracts degeneration in Friedreich ataxia. An in vivo MRI study using tract-based spatial statistics and voxel-based morphometry. 40:19–25, 200810.1016/j.neuroimage.2007.11.050)| false
KusanoYTanakaYTakasunaHWadaNTadaTKakizawaY: Transient cerebellar mutism caused by bilateral damage to the dentate nuclei after the second posterior fossa surgery. Case report. J Neurosurg104:329–3312006
KusanoY, TanakaY, TakasunaH, WadaN, TadaT, KakizawaY, : Transient cerebellar mutism caused by bilateral damage to the dentate nuclei after the second posterior fossa surgery. Case report. 104:329–331, 20061650951010.3171/jns.2006.104.2.329)| false
OhMEDrieverPHKhajuriaRKRueckriegelSMKoustenisEBruhnH: DTI fiber tractography of cerebro-cerebellar pathways and clinical evaluation of ataxia in childhood posterior fossa tumor survivors. J Neurooncol131:267–2762017
PoldersDL, LeemansA, HendrikseJ, DonahueMJ, LuijtenPR, HoogduinJM: Signal to noise ratio and uncertainty in diffusion tensor imaging at 1.5, 3.0, and 7.0 Tesla. 33:1456–1463, 201110.1002/jmri.2255421591016)| false
RivaD, GiorgiC: The cerebellum contributes to higher functions during development: evidence from a series of children surgically treated for posterior fossa tumours. 123:1051–1061, 20001077554910.1093/brain/123.5.1051)| false
VollmarCO’MuircheartaighJBarkerGJSymmsMRThompsonPKumariV: Identical, but not the same: intra-site and inter-site reproducibility of fractional anisotropy measures on two 3.0T scanners. Neuroimage51:1384–13942010
VollmarC, O’MuircheartaighJ, BarkerGJ, SymmsMR, ThompsonP, KumariV, : Identical, but not the same: intra-site and inter-site reproducibility of fractional anisotropy measures on two 3.0T scanners. 51:1384–1394, 201010.1016/j.neuroimage.2010.03.04620338248)| false
ZhouXSakaieKEDebbinsJPNarayananSFoxRJLoweMJ: Scan-rescan repeatability and cross-scanner comparability of DTI metrics in healthy subjects in the SPRINT-MS multicenter trial. Magn Reson Imaging53:105–1112018
ZhouX, SakaieKE, DebbinsJP, NarayananS, FoxRJ, LoweMJ: Scan-rescan repeatability and cross-scanner comparability of DTI metrics in healthy subjects in the SPRINT-MS multicenter trial. 53:105–111, 201810.1016/j.mri.2018.07.01130048675)| false