Abstract：
Cerebellar mutism syndrome (CMS) is a well-known complication after posterior fossa tumor surgery in pediatric patients. We evaluated the incidence of CMS in our institute and analyzed its association with multiple risk factors, such as tumor entity, surgical approach, and hydrocephalus.
All pediatric patients who had undergone intra-axial tumor resection in the posterior fossa between January 2010 and March 2021 were included in the retrospective analysis. Various data points, including demographic, tumor-associated, clinical, radiological, surgery-associated, complications, and follow-up data, were collected and statistically evaluated for an association with CMS.
A total of 63 surgeries in 60 patients were included. The median patient age was 8 years. Pilocytic astrocytoma was the most common tumor type (50%), followed by medulloblastoma (28%) and ependymomas (10%). Complete, subtotal, and partial resection was achieved in 67%, 23%, and 10%, respectively. A telovelar approach had been used the most often (43%) compared with a transvermian approach (8%). Of the 60 children, 10 (17%) had developed CMS and showed marked improvement but with residual deficits. The significant risk factors were a transvermian approach (P = 0.03), vermian splitting when added to another approach (P = 0.002), an initial presentation with acute hydrocephalus (P = 0.02), and hydrocephalus present after tumor surgery (P = 0.004).
Our CMS rate is comparable to those described in the literature. Despite the limitations of the retrospective study design, we found that CMS was not only associated with a transvermian approach but was also associated with a telovelar approach, although to a lesser extent. Acute hydrocephalus at the initial presentation necessitating urgent management was significantly associated with a greater incidence of CMS.
All pediatric patients who had undergone intra-axial tumor resection in the posterior fossa between January 2010 and March 2021 were included in the retrospective analysis. Various data points, including demographic, tumor-associated, clinical, radiological, surgery-associated, complications, and follow-up data, were collected and statistically evaluated for an association with CMS.
A total of 63 surgeries in 60 patients were included. The median patient age was 8 years. Pilocytic astrocytoma was the most common tumor type (50%), followed by medulloblastoma (28%) and ependymomas (10%). Complete, subtotal, and partial resection was achieved in 67%, 23%, and 10%, respectively. A telovelar approach had been used the most often (43%) compared with a transvermian approach (8%). Of the 60 children, 10 (17%) had developed CMS and showed marked improvement but with residual deficits. The significant risk factors were a transvermian approach (P = 0.03), vermian splitting when added to another approach (P = 0.002), an initial presentation with acute hydrocephalus (P = 0.02), and hydrocephalus present after tumor surgery (P = 0.004).
Our CMS rate is comparable to those described in the literature. Despite the limitations of the retrospective study design, we found that CMS was not only associated with a transvermian approach but was also associated with a telovelar approach, although to a lesser extent. Acute hydrocephalus at the initial presentation necessitating urgent management was significantly associated with a greater incidence of CMS.
摘要：
目的：小脑mutism综合征（CMS）是儿科患者后颅窝肿瘤手术后的一种众所周知的并发症。我们评估了我们研究所的CMS发生率，并分析了与多种危险因素的关联，如肿瘤实体，手术方法,和脑积水.
方法：纳入2010年1月至2021年3月接受后颅窝轴向内肿瘤切除术的所有儿科患者进行回顾性分析。各种数据点，包括人口统计，肿瘤相关，临床,放射学,手术相关，收集并发症和随访数据,并对与CMS的相关性进行统计学评估.
结果：纳入60例患者的63例手术，中位年龄为8岁。毛细胞性星形细胞瘤主要占50％，其次是28%的髓母细胞瘤，室管膜瘤占10%.67％的完全切除率与23％的次全切除率相比，部分切除10%。Telovelar方法使用最多的是43％，而transvermian则为8％。10名儿童（17％）发生了CMS，并表现出明显改善，但仍有缺陷。显著的危险因素是超虫方法(p=0.03)，每当添加到其他方法时，Vermian分裂(p=0.002)，最初表现为急性脑积水（p=0.02），肿瘤手术后仍有脑积水(p=0.004)。
结论：我们的CMS率与文献中描述的比较。尽管我们作为回顾性研究的局限性，我们发现CMS不仅与超虫方法有关，但也发生在使用telovelar方法后，然而，在较小的程度上。初次出现时需要紧急处理的急性脑积水与CMS的发病率较高密切相关。
方法：纳入2010年1月至2021年3月接受后颅窝轴向内肿瘤切除术的所有儿科患者进行回顾性分析。各种数据点，包括人口统计，肿瘤相关，临床,放射学,手术相关，收集并发症和随访数据,并对与CMS的相关性进行统计学评估.
结果：纳入60例患者的63例手术，中位年龄为8岁。毛细胞性星形细胞瘤主要占50％，其次是28%的髓母细胞瘤，室管膜瘤占10%.67％的完全切除率与23％的次全切除率相比，部分切除10%。Telovelar方法使用最多的是43％，而transvermian则为8％。10名儿童（17％）发生了CMS，并表现出明显改善，但仍有缺陷。显著的危险因素是超虫方法(p=0.03)，每当添加到其他方法时，Vermian分裂(p=0.002)，最初表现为急性脑积水（p=0.02），肿瘤手术后仍有脑积水(p=0.004)。
结论：我们的CMS率与文献中描述的比较。尽管我们作为回顾性研究的局限性，我们发现CMS不仅与超虫方法有关，但也发生在使用telovelar方法后，然而，在较小的程度上。初次出现时需要紧急处理的急性脑积水与CMS的发病率较高密切相关。
