Association between cerebral perfusion and paediatric postoperative cerebellar mutism syndrome after posterior fossa surgery—a systematic review

Background Paediatric postoperative cerebellar mutism syndrome (ppCMS) is a common complication following the resection of a cerebellar tumour in children. It is hypothesized that loss of integrity of the cerebellar output tracts results in a cerebello-cerebral “diaschisis” and reduced function of s...

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Bibliographic Details
Published in:Child's nervous system 2021-09, Vol.37 (9), p.2743-2751
Main Authors: Ahmadian, Narjes, van Baarsen, K. M., Robe, P. A. J. T., Hoving, E. W.
Format: Article
Language:English
Subjects:
Case-Control Studies
Cerebellar Diseases - diagnostic imaging
Cerebellar Diseases - etiology
Cerebellum - diagnostic imaging
Cerebrovascular Circulation
Child
Humans
Medicine
Medicine & Public Health
Mutism - diagnostic imaging
Mutism - etiology
Neurosciences
Neurosurgery
Perfusion
Postoperative Complications - diagnostic imaging
Postoperative Complications - etiology
Prospective Studies
Retrospective Studies
Review
Review Article
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Summary:Background Paediatric postoperative cerebellar mutism syndrome (ppCMS) is a common complication following the resection of a cerebellar tumour in children. It is hypothesized that loss of integrity of the cerebellar output tracts results in a cerebello-cerebral “diaschisis” and reduced function of supratentorial areas of the brain. Methods We performed a systematic review of the literature according to the PRISMA guidelines, in order to evaluate the evidence for hypoperfusion or hypofunction in the cerebral hemispheres in patients with ppCMS. Articles were selected based on the predefined eligibility criteria and quality assessment. Results Five studies were included, consisting of three prospective cohort studies, one retrospective cohort study and one retrospective case control study. Arterial spin labelling (ASL) perfusion MRI, dynamic susceptibility contrast (DSC) perfusion MRI and single photon emission computed tomography (SPECT) were used to measure the cerebral and cerebellar tissue perfusion or metabolic activity. Reduced cerebral perfusion was predominantly demonstrated in the frontal lobe. Conclusions This systematic review shows that, after posterior fossa tumour resection, cerebral perfusion is reduced in ppCMS patients compared to patients without ppCMS. Well-powered prospective studies, including preoperative imaging, are needed to ascertain the cause and role of hypoperfusion in the pathophysiology of the syndrome.
ISSN:0256-7040
1433-0350
DOI:10.1007/s00381-021-05225-5