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Child's Nervous System

, Volume 11, Issue 5, pp 306–310 | Cite as

Transient mutism following a posterior fossa approach to cerebellar tumors in children: a critical review of the literature

  • Paulo Henrique Aguiar
  • José Pindaro P. Plese
  • Orildo Ciquini
  • Raul Marino
Case Report

Abstract

Transient mutism has been known as a rare complication following a posterior fossa approach to cerebellar tumors and its cause has not been clearly elucidated. The cerebellar mutism is not accompanied by cranial nerve deficits and disorders of consciousness. Since 1985 only 23 cases of mutism following removal of a cerebellar tumor in children have been reported in the literature. Two additional cases have been operated upon in our department. Extensive injury to the vermian and paravermian cerebellar area, involving the hemispheric cortex, cerebellar peduncles, fibers from the dentato-thalamocortical pathway, and dentate and interpositum nuclei may be the most important anatomical substrate of mutism. The mechanism of such transient mutism seems to be a complex of two or more factors (vascular disturbances due to manipulation or retraction of the cerebellar region around the IV ventricle and emotional factors). On the basis of these 25 cases the major features of the cerebellar mutism are discussed.

Key words

Cerebellar neoplasm Posterior fossa tumor Mutism Aphasia 

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References

  1. 1.
    Altshuler LL, Cummings JL, Mills MJ (1986) Mutism: review, differential diagnosis and report of 22 cases. Am J Psychiatry 143:1409–1414Google Scholar
  2. 2.
    Amici R, Avanzini G, Palini L (1976) Cerebellar tumours. Clinical analysis and physiopathologic correlations. (Monographs in neural sciences, vol 4) Karger, BaselGoogle Scholar
  3. 3.
    Ammirati M, Mirzai S, Samii M (1989) Transient mutism following removal of a cerebellar tumor. A case report and review of the literature. Child's Nerv Syst 5:12–14Google Scholar
  4. 4.
    Benson DF (1979) Aphasia, alexia, and agraphia. Churchill Livingstone, New YorkGoogle Scholar
  5. 5.
    Dietze DD, Mickle JP (1990–1991) Cerebellar mutism after posterior fossa surgery. Pediatr Neurosurg 16:25–31Google Scholar
  6. 6.
    Ferrante L, Mastrornardi L, Acqui M, Fortuna A (1990) Mutism after posterior fossa surgery in children: report of three cases. J Neurosurg 72:959–963Google Scholar
  7. 7.
    Fraioli B, Guidetti B (1975) Effects of sterotactic lesions of the dentate nucleus of cerebellum in man. Appl Neurophysiol 38:81–90Google Scholar
  8. 8.
    Gilman S, Lechtenberg R (1981) Cerebellar dysarthria. In: Gilman S (ed) Disorders of the cerebellum. Davis, Philadelphia, pp 223–230Google Scholar
  9. 9.
    Guidetti B, Fraioli B (1977) Neurosurgical treatment of spasticity and dyskinesias. Acta Neurochir (Wien) 24 [Suppl]:27–39Google Scholar
  10. 10.
    Humphreys RP (1989) Mutism after posterior fossa tumor surgery. In: Marlin AE (ed) Concepts in pediatric neurosurgery, vol 9. Karger, Basel, pp 57–64Google Scholar
  11. 11.
    Lechtenberg R, Gilman S (1978) Speech disorders in cerebellar disease. Ann Neurol 3:285–290Google Scholar
  12. 12.
    Maire JP, Guérin J, Rivel J, San Galli F, Bernard C, Dautheribes M, Caudry M (1992) Le médulloblastome de l'enfant: incidence prognostique de l'hyperplasie vasculaire, de la nécrose, de coagulation, et de l'état clinique post-opératoire sur la survie. Neurochirurgie 38:80–88Google Scholar
  13. 13.
    Matsushima T, Rothon AL Jr, Lenkey C (1982) Microsurgery of the fourth ventricle. Neurosurgery 11:631–667Google Scholar
  14. 14.
    Nagatani K, Waga S, Nakagawa Y (1991) Mutism after removal of a vermian medulloblastoma: cerebellar mutism. Surg Neurol 36:307–309Google Scholar
  15. 15.
    Nakasu Y, Isgumi T, Nioka H, Handa J (1991) Mechanism of mutism following the transcallosal approach to the ventricles. Acta Neurochir (Wien) 110:146–156Google Scholar
  16. 16.
    Raimondi AJ (1987) Pediatric neurosurgery. Springer, New York Berlin HeidelbergGoogle Scholar
  17. 17.
    Rekate HL, Grubb RL, Aram DM, Hahn JF, Ratcheson RA (1985) Muteness of cerebellar origin. Arch Neurol 42:697–698Google Scholar
  18. 18.
    Salvati M, Missori P, Lunardi, Orlando ER (1991) Transient cerebellar mutism after posterior cranial fossa surgery in an adult. Clin Neurol Neurosurg 93–94:313–316Google Scholar
  19. 19.
    Siegfried J, Esslen E, Gretener U, et al (1970) Functional anatomy of the dentate nucleus in the light of stereotaxic operations. Confin Neurol 32:1–10Google Scholar
  20. 20.
    Tolbert DL, Bantli H, Bloedel JR (1978) Organizational features of the cat and monkey cerebellar nucleocortical projections. J Comp Neurol 182:39–56Google Scholar
  21. 21.
    Volcan I, Cole GP, Johnston K (1986) A case of muteness of cerebellar origin (letter). Arch Neurol 48:313–314Google Scholar
  22. 22.
    Wisoff JH, Epstein FJ (1984) Pseudobulbar palsy after posterior fossa operation in children. Neurosurgery 15:707–709Google Scholar
  23. 23.
    Yonemasu Y (1985) “Cerebelar mutism” and speech disturbance as a complication of posterior fossa surgery in children. Presented at the 13th Annual Meeting of the Japanese Society for Pediatric Neurosurgery, Tsukuba, JapanGoogle Scholar

Copyright information

© Springer-Verlag 1995

Authors and Affiliations

  • Paulo Henrique Aguiar
    • 1
  • José Pindaro P. Plese
    • 1
  • Orildo Ciquini
    • 1
  • Raul Marino
    • 1
  1. 1.Division of Neurosurgery, Department of Neurology, Hospital das ClínicasUniversity of São PauloSão PauloBrazil

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