Child's Nervous System, April, 2013, Vol.29(4), p.597(11)
Byline: Verena Soelva (1), Pablo Hernaiz Driever (2), Alexander Abbushi (1), Stefan Rueckriegel (2), Harald Bruhn (3), Wilhelm Eisner (4), Ulrich-Wilhelm Thomale (1) Keywords: Diffusion tensor imaging; Tractography; Pediatric brain tumor; Posterior fossa surgery; Cerebellar mutism Abstract: Objective Fronto-cerebellar association fibers (FCF) are involved in neurocognitive regulatory circuitry. This may also be relevant for cerebellar mutism syndrome (CMS) as a complication following posterior fossa tumor removal in children. In the present study, we investigated FCF by diffusion tensor imaging in affected children and controls. Methods Diffusion-weighted MR imaging at 3 T (GE) allowed tractography of FCF using a fiber tracking algorithm software (Brainlab 2.6) in 29 patients after posterior fossa tumor removal and in 10 healthy peers. Fiber tract volumes were assessed and fiber signals were evaluated in a semiquantitative manner along the anatomical course. Results Volumes of FCF revealed significant diminished values in pediatric patients with symptoms of CMS (19.3+-11.7 cm.sup.3) when compared with patients without symptoms of CMS (26.9+-11.9 cm.sup.3) and with healthy peers (36.5+-13.82 cm.sup.3). In medulloblastoma patients, the volume of FCF was also significantly reduced in patients with symptoms of CMS despite having the same antitumor therapy. In semiquantitative analysis of the fiber tract signals, differences were observed in the superior cerebellar peduncles and midline cerebellar structures in patients with symptoms of CMS. Conclusion Using DTI, which allows the visualization of fronto-cerebellar fiber tracts, lower FCF tract volumes and diminished fiber signal intensities at the level of the superior cerebellar peduncles and in midline cerebellar structures were identified in patients with postoperative symptoms of CMS. Our study refers to the role of a neural circuitry between frontal lobes and the cerebellum being involved in neurocognitive impairment after posterior fossa tumor treatment in children. Author Affiliation: (1) Arbeitsbereich Padiatrische Neurochirurgie, Charite-Universitatsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany (2) Klinik fur Padiatrie mit Schwerpunkt Onkologie und Hamatologie, Berlin, Germany (3) Radiologie, Charite-Universitatsmedizin Berlin, Berlin, Germany (4) Neurochirurgische Klinik, Medizinischen Universitat Innsbruck, Innsbruck, Austria Article History: Registration Date: 14/11/2012 Received Date: 03/09/2012 Accepted Date: 13/11/2012 Online Date: 27/11/2012
Mutism -- Causes Of ; Mutism -- Diagnosis ; Mutism -- Care And Treatment ; Mutism -- Research ; Tumor Removal -- Complications And Side Effects ; Tumor Removal -- Research
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