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Diffusion Tensor Imaging Technique Delineating the Prognosis for Cerebellar Mutism in Posterior Fossa Tumors: A New Tool

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The Funnel: From the Skull Base to the Sacrum

Part of the book series: Acta Neurochirurgica Supplement ((NEUROCHIRURGICA,volume 135))

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Abstract

Aim: Cerebellar mutism syndrome (CMS) is a morbid complication of posterior fossa surgery in children. This review focuses on the current understanding of pathophysiology in the white matter tracts (WMT) using diffusion tensor imaging (DTI).

Material and Methods: A series of 38 patients operated on for posterior fossa tumors in our institute between December 2019 till May 2021 were evaluated neurologically along with characteristics of mutism and DTI imaging (fractional anisotropy) in preoperative and postoperative periods. We also noted tumor size, location, volume, brainstem compression, cerebellar peduncle involvement, extent of resection, surgical approach, and histopathology.

Result: Cerebellar mutism developed in five patients. The mean age, male sex, tumor size >5 cm, superior cerebellar peduncle involvement, and vermian incision were found to have positive correlation with the development of CMS. They showed reduction in fractional anisotropy in superior cerebellar peduncle (SCP) following resection; however, others’ WMT did not show any significant change in fractional anisotropy values pre- or post-surgery.

Conclusion: Our study suggests that functional disruption of WMT, i.e., superior cerebellar peduncle and dentato-thalamo-cortical tract (DTC) is the underlying pathophysiological component of CMS. Taking this into consideration, we need to deploy techniques to limit the damage to the superior cerebellar peduncle and DTC using neurophysiological monitoring.

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Abbreviations

CMS:

Cerebellar mutism syndrome

DTC:

Dentato-thalamo-cortical tract

DTI:

Diffusion tensor imaging

FA:

Fractional anisotropy

SCP:

Superior cerebellar peduncle

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Authors and Affiliations

  1. Department of neurosurgery, SMS Medical College and Hospital, Jaipur, Rajasthan, India

    V. D. Sinha, Patni Ankur & Jain Gaurav

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  1. V. D. Sinha
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  2. Patni Ankur
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Editors and Affiliations

  1. Institute of Neurosurgery, Catholic University of Rome, Rome, Italy

    Massimiliano Visocchi

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Sinha, V.D., Ankur, P., Gaurav, J. (2023). Diffusion Tensor Imaging Technique Delineating the Prognosis for Cerebellar Mutism in Posterior Fossa Tumors: A New Tool. In: Visocchi, M. (eds) The Funnel: From the Skull Base to the Sacrum. Acta Neurochirurgica Supplement, vol 135. Springer, Cham. https://doi.org/10.1007/978-3-031-36084-8_10

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  • DOI: https://doi.org/10.1007/978-3-031-36084-8_10

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  • Online ISBN: 978-3-031-36084-8

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