Child's Nervous System

, Volume 27, Issue 3, pp 355–363 | Cite as

Cerebellar mutism

Review of the literature
  • Thora Gudrunardottir
  • Astrid Sehested
  • Marianne Juhler
  • Kjeld Schmiegelow
Review Paper

Abstract

Purpose

Cerebellar mutism is a common complication of posterior fossa surgery in children. This article reviews current status with respect to incidence, anatomical substrate, pathophysiology, risk factors, surgical considerations, treatment options, prognosis and prevention.

Methods

We reviewed all peer-reviewed English publications on cerebellar mutism between the years of 1985 and 2009. The majority were found by searching for ‘cerebellar mutism’ and ‘posterior fossa syndrome’ in PubMed. Additional cases were identified by cross-checking reference lists.

Results

The overall incidence of postoperative cerebellar mutism is 11–29%, and patients with medulloblastomas and/or brainstem invasion are at a greater risk of developing it than those with other kinds of tumors and/or without brainstem invasion. Permanent sequelae in the form of both motor- and non-motor-related speech deficits are common, especially when the right cerebellar hemisphere is involved. The mutism is caused by bilateral pertubation of the dentate nuclei and their efferent pathways, which emphasizes the need to explore surgical methods that spare these structures. The pathophysiological mechanisms of delayed onset and resolution of cerebellar mutism are not clear, but axonal damage, edema, perfusional defects and metabolic disturbances may be involved.

Conclusion

The incidence of cerebellar mutism is well documented in children with medulloblastoma, but precise figures for those with astrocytoma and ependymoma are lacking. Further anatomical, functional imaging and neuropsychological studies are needed to clarify the pathophysiological mechanisms in order to define preventive measures during surgery. Randomized, controlled trials of the effects of different medication and post-operative speech therapy are necessary for improving treatment.

Keywords

Cerebellar mutism Brain tumor Posterior fossa surgery Children Speech disorder Review 

References

  1. 1.
    Rekate HL, Grubb RL, Aram DM, Hahn JF, Ratcheson RA (1985) Muteness of cerebellar origin. Arch Neurol 42:697–698PubMedGoogle Scholar
  2. 2.
    Frassanito P, Massimi L, Caldarelli M, Di RC (2009) Cerebellar mutism after spontaneous intratumoral bleeding involving the upper cerebellar vermis: a contribution to the physiopathogenic interpretation. Childs Nerv Syst 25:7–11PubMedCrossRefGoogle Scholar
  3. 3.
    Robertson PL, Muraszko KM, Holmes EJ, Sposto R, Packer RJ, Gajjar A, Dias MS, Allen JC (2006) Incidence and severity of postoperative cerebellar mutism syndrome in children with medulloblastoma: a prospective study by the Children’s Oncology Group. J Neurosurg 105:444–451PubMedGoogle Scholar
  4. 4.
    Ersahin Y, Mutluer S, Saydam S, Barcin E (1997) Cerebellar mutism: report of two unusual cases and review of the literature. Clin Neurol Neurosurg 99:130–134PubMedCrossRefGoogle Scholar
  5. 5.
    Fujisawa H, Yonaha H, Okumoto K, Uehara H, Ie T, Nagata Y, Suehiro E, Suzuki M (2005) Mutism after evacuation of acute subdural hematoma of the posterior fossa. Childs Nerv Syst 21:234–236PubMedCrossRefGoogle Scholar
  6. 6.
    Al-Anazi A, Hassounah M, Sheikh B, Barayan S (2001) Cerebellar mutism caused by arteriovenous malformation of the vermis. Br J Neurosurg 15:47–50PubMedCrossRefGoogle Scholar
  7. 7.
    Baillieux H, Weyns F, Paquier P, De Deyn PP, Marien P (2007) Posterior fossa syndrome after a vermian stroke: a new case and review of the literature. Pediatr Neurosurg 43:386–395PubMedCrossRefGoogle Scholar
  8. 8.
    Coplin WM, Kim DK, Kliot M, Bird TD (1997) Mutism in an adult following hypertensive cerebellar hemorrhage: nosological discussion and illustrative case. Brain Lang 59:473–493PubMedCrossRefGoogle Scholar
  9. 9.
    Dietze DD Jr, Mickle JP (1990) Cerebellar mutism after posterior fossa surgery. Pediatr Neurosurg 16:25–31PubMedCrossRefGoogle Scholar
  10. 10.
    Dunwoody GW, Alsagoff ZS, Yuan SY (1997) Cerebellar mutism with subsequent dysarthria in an adult: case report. Br J Neurosurg 11:161–163PubMedCrossRefGoogle Scholar
  11. 11.
    Koh S, Turkel SB, Baram TZ (1997) Cerebellar mutism in children: report of six cases and potential mechanisms. Pediatr Neurol 16:218–219PubMedCrossRefGoogle Scholar
  12. 12.
    Sinha AK, Rajender Y, Dinakar I (1998) Transient cerebellar mutism after evacuation of a spontaneous vermian haematoma. Childs Nerv Syst 14:460–462PubMedCrossRefGoogle Scholar
  13. 13.
    Turkel SB, Shu CL, Nelson MD, Hyder D, Gilles FH, Woodall L, Braslow K, Tavare CJ (2004) Case series: acute mood symptoms associated with posterior fossa lesions in children. J Neuropsychiatry Clin Neurosci 16:443–445PubMedGoogle Scholar
  14. 14.
    Vandeinse D, Hornyak JE (1997) Linguistic and cognitive deficits associated with cerebellar mutism. Pediatr Rehabil 1:41–44PubMedGoogle Scholar
  15. 15.
    Drost G, Verrips A, Thijssen HO, Gabreels (2000) Cerebellar involvement as a rare complication of pneumococcal meningitis. Neuropediatrics 31:97–99PubMedCrossRefGoogle Scholar
  16. 16.
    Mewasingh LD, Kadhim H, Christophe C, Christiaens FJ, Dan B (2003) Nonsurgical cerebellar mutism (anarthria) in two children. Pediatr Neurol 28:59–63PubMedCrossRefGoogle Scholar
  17. 17.
    Papavasiliou AS, Kotsalis C, Trakadas S (2004) Transient cerebellar mutism in the course of acute cerebellitis. Pediatr Neurol 30:71–74PubMedCrossRefGoogle Scholar
  18. 18.
    Riva D (1998) The cerebellar contribution to language and sequential functions: evidence from a child with cerebellitis. Cortex 34:279–287PubMedCrossRefGoogle Scholar
  19. 19.
    Shiihara T, Watanabe M, Honma A, Kato M, Morita Y, Ichiyama T, Maruyama K (2007) Rotavirus associated acute encephalitis/encephalopathy and concurrent cerebellitis: report of two cases. Brain Dev 29:670–673PubMedCrossRefGoogle Scholar
  20. 20.
    Aguiar PH, Plese JP, Ciquini O, Marino R (1993) Cerebellar mutism after removal of a vermian medulloblastoma: literature review. Pediatr Neurosurg 19:307Google Scholar
  21. 21.
    Aguiar PH, Plese JP, Ciquini O, Marino R (1995) Transient mutism following a posterior fossa approach to cerebellar tumors in children: a critical review of the literature. Childs Nerv Syst 11:306–310PubMedCrossRefGoogle Scholar
  22. 22.
    Bhatoe HS (1997) Mutism, oropharyngeal apraxia and dysarthria after posterior fossa tumour excision. Br J Neurosurg 11:341–343PubMedCrossRefGoogle Scholar
  23. 23.
    Cakir Y, Karakisi D, Kocanaogullari O (1994) Cerebellar mutism in an adult: case report. Surg Neurol 41:342–344PubMedCrossRefGoogle Scholar
  24. 24.
    Clerico A, Sordi A, Ragni G, Festa A, Cappelli C, Maini CL (2002) Brief report: transient mutism following posterior fossa surgery studied by single photon emission computed tomography (SPECT). Med Pediatr Oncol 38:445–448PubMedCrossRefGoogle Scholar
  25. 25.
    Di Cataldo A, Dollo C, Astuto M, La Spina M, Ippolito S, Papotto M, Giuffrida S (2001) Mutism after surgical removal of a cerebellar tumor: two case reports. Pediatr Hematol Oncol 18:117–121PubMedCrossRefGoogle Scholar
  26. 26.
    Ersahin Y, Mutluer S, Cagli S, Duman Y (1996) Cerebellar mutism: report of seven cases and review of the literature. Neurosurgery 38:60–65PubMedCrossRefGoogle Scholar
  27. 27.
    Humphreys RP (1989) Mutism after posterior fossa tumor surgery. Concepts Pediatr Neurosurg 9:57–64Google Scholar
  28. 28.
    Jones S, Kirollos RW, Van Hille PT (1996) Cerebellar mutism following posterior fossa tumour surgery. Br J Neurosurg 10:221–224PubMedCrossRefGoogle Scholar
  29. 29.
    Liu GT, Phillips PC, Molloy PT, Needle MN, Galetta SL, Balcer LJ, Schut L, Duhaime AC, Sutton LN (1998) Visual impairment associated with mutism after posterior fossa surgery in children. Neurosurgery 42:253–256PubMedCrossRefGoogle Scholar
  30. 30.
    McMinn P, Stratov I, Nagarajan L, Davis S (2001) Neurological manifestations of enterovirus 71 infection in children during an outbreak of hand, foot, and mouth disease in Western Australia. Clin Infect Dis 32:236–242PubMedCrossRefGoogle Scholar
  31. 31.
    Miyakita Y, Taguchi Y, Sakakibara Y, Matsuzawa M, Kitagawa H (1999) Transient mutism resolving into cerebellar speech after brain stem infarction following a traumatic injury of the vertebral artery in a child. Acta Neurochir (Wien) 141:209–213CrossRefGoogle Scholar
  32. 32.
    Arslantas A, Erhan C, Emre E, Esref T (2002) Transient cerebellar mutism after posterior fossa surgery. J Postgrad Med 48:158–159PubMedGoogle Scholar
  33. 33.
    D’Avanzo R, Scuotto A, Natale M, Scotto P, Cioffi FA (1993) Transient “cerebellar” mutism in lesions of the mesencephalic–cerebellar region. Acta Neurol (Napoli) 15:289–296Google Scholar
  34. 34.
    Huber JF, Bradley K, Spiegler BJ, Dennis M (2006) Long-term effects of transient cerebellar mutism after cerebellar astrocytoma or medulloblastoma tumor resection in childhood. Childs Nerv Syst 22:132–138PubMedCrossRefGoogle Scholar
  35. 35.
    Huber JF, Bradley K, Spiegler B, Dennis M (2007) Long-term neuromotor speech deficits in survivors of childhood posterior fossa tumors: effects of tumor type, radiation, age at diagnosis, and survival years. J Child Neurol 22:848–854PubMedCrossRefGoogle Scholar
  36. 36.
    Sinha AK, Rajender Y, Dinakar I (1998) Transient cerebellar mutism after evacuation of a spontaneous vermian haematoma. Childs Nerv Syst 14:460–462PubMedCrossRefGoogle Scholar
  37. 37.
    Van Calenbergh F, Van de Laar A, Plets C, Goffin J, Casaer P (1995) Transient cerebellar mutism after posterior fossa surgery in children. Neurosurgery 37:894–898PubMedCrossRefGoogle Scholar
  38. 38.
    Catsman-Berrevoets CE, van Dongen HR, Mulder PG, Geuze D, Paquier PF, Lequin MH (1999) Tumour type and size are high risk factors for the syndrome of “cerebellar” mutism and subsequent dysarthria. J Neurol Neurosurg Psychiatry 67:755–757PubMedCrossRefGoogle Scholar
  39. 39.
    van Dongen HR, Catsman-Berrevoets CE, Van Mourik M (1994) The syndrome of ‘cerebellar’ mutism and subsequent dysarthria. Neurology 44:2040–2046PubMedGoogle Scholar
  40. 40.
    Janssen G, Messing-Junger AM, Engelbrecht V, Gobel U, Bock WJ, Lenard HG (1998) Cerebellar mutism syndrome. Klin Padiatr 210:243–247PubMedCrossRefGoogle Scholar
  41. 41.
    Kellogg JX, Piatt JH Jr (1997) Resection of fourth ventricle tumors without splitting the vermis: the cerebellomedullary fissure approach. Pediatr Neurosurg 27:28–33PubMedCrossRefGoogle Scholar
  42. 42.
    Kotil K, Eras M, Akcetin M, Bilge T (2008) Cerebellar mutism following posterior fossa tumor resection in children. Turk Neurosurg 18:89–94PubMedGoogle Scholar
  43. 43.
    Salvati M, Missori P, Lunardi P, Orlando ER (1991) Transient cerebellar mutism after posterior cranial fossa surgery in an adult. Case report and review of the literature. Clin Neurol Neurosurg 93:313–316PubMedCrossRefGoogle Scholar
  44. 44.
    Siffert J, Poussaint TY, Goumnerova LC, Scott RM, LaValley B, Tarbell NJ, Pomeroy SL (2000) Neurological dysfunction associated with postoperative cerebellar mutism. J Neurooncol 48:75–81PubMedCrossRefGoogle Scholar
  45. 45.
    Gelabert-Gonzalez M, Fernandez-Villa J (2001) Mutism after posterior fossa surgery. Review of the literature. Clin Neurol Neurosurg 103:111–114PubMedCrossRefGoogle Scholar
  46. 46.
    Marien P, Engelborghs S, Fabbro F, De Deyn PP (2001) The lateralized linguistic cerebellum: a review and a new hypothesis. Brain Lang 79:580–600PubMedCrossRefGoogle Scholar
  47. 47.
    Turgut M (1998) Transient “cerebellar” mutism. Childs Nerv Syst 14:161–166PubMedCrossRefGoogle Scholar
  48. 48.
    Steinbok P, Cochrane DD, Perrin R, Price A (2003) Mutism after posterior fossa tumour resection in children: incomplete recovery on long-term follow-up. Pediatr Neurosurg 39:179–183PubMedCrossRefGoogle Scholar
  49. 49.
    Aarsen FK, van Dongen HR, Paquier PF, van MM, Catsman-Berrevoets CE (2004) Long-term sequelae in children after cerebellar astrocytoma surgery. Neurology 62:1311–1316PubMedGoogle Scholar
  50. 50.
    Pollack IF (2001) Neurobehavioral abnormalities after posterior fossa surgery in children. Int Rev Psychiatry 13:302–312CrossRefGoogle Scholar
  51. 51.
    Baillieux H, De Smet HJ, Paquier PF, De Deyn PP, Marien P (2008) Cerebellar neurocognition: insights into the bottom of the brain. Clin Neurol Neurosurg 110:763–773PubMedCrossRefGoogle Scholar
  52. 52.
    Doxey D, Bruce D, Sklar F, Swift D, Shapiro K (1999) Posterior fossa syndrome: identifiable risk factors and irreversible complications. Pediatr Neurosurg 31:131–136PubMedCrossRefGoogle Scholar
  53. 53.
    Kirk EA, Howard VC, Scott CA (1995) Description of posterior fossa syndrome in children after posterior fossa brain tumor surgery. J Pediatr Oncol Nurs 12:181–187PubMedGoogle Scholar
  54. 54.
    Pollack IF (1997) Posterior fossa syndrome. Int Rev Neurobiol 41:411–432PubMedCrossRefGoogle Scholar
  55. 55.
    Pollack IF, Polinko P, Albright AL, Towbin R, Fitz C (1995) Mutism and pseudobulbar symptoms after resection of posterior fossa tumors in children: incidence and pathophysiology. Neurosurgery 37:885–893PubMedCrossRefGoogle Scholar
  56. 56.
    Stoodley CJ, Schmahmann JD (2010) Evidence for topographic organization in the cerebellum of motor control versus cognitive and affective processing. CortexGoogle Scholar
  57. 57.
    Stoodley CJ, Schmahmann JD (2008) Functional topography in the human cerebellum: a meta-analysis of neuroimaging studies. Neuroimage 44:489–501PubMedCrossRefGoogle Scholar
  58. 58.
    Riva D, Giorgi C (2000) The cerebellum contributes to higher functions during development: evidence from a series of children surgically treated for posterior fossa tumours. Brain 123(Pt 5):1051–1061PubMedCrossRefGoogle Scholar
  59. 59.
    Ersahin Y, Yararbas U, Duman Y, Mutluer S (2002) Single photon emission tomography following posterior fossa surgery in patients with and without mutism. Childs Nerv Syst 18:318–325PubMedCrossRefGoogle Scholar
  60. 60.
    Ozimek A, Richter S, Hein-Kropp C, Schoch B, Gorissen B, Kaiser O, Gizewski E, Ziegler W, Timmann D (2004) Cerebellar mutism—report of four cases. J Neurol 251:963–972PubMedCrossRefGoogle Scholar
  61. 61.
    Morris EB, Phillips NS, Laningham FH, Patay Z, Gajjar A, Wallace D, Boop F, Sanford R, Ness KK, Ogg RJ (2009) Proximal dentatothalamocortical tract involvement in posterior fossa syndrome. Brain 132:3087–3095PubMedCrossRefGoogle Scholar
  62. 62.
    Puget S, Boddaert N, Viguier D, Kieffer V, Bulteau C, Garnett M, Callu D, Sainte-Rose C, Kalifa C, Dellatolas G, Grill J (2009) Injuries to inferior vermis and dentate nuclei predict poor neurological and neuropsychological outcome in children with malignant posterior fossa tumors. Cancer 115:1338–1347PubMedCrossRefGoogle Scholar
  63. 63.
    Catsman-Berrevoets CE, Van Breemen M, van Veelen ML, Appel IM, Lequin MH (2005) Supratentorial arterial ischemic stroke following cerebellar tumor resection in two children. Pediatr Neurosurg 41:206–211PubMedCrossRefGoogle Scholar
  64. 64.
    Crutchfield JS, Sawaya R, Meyers CA, Moore BD III (1994) Postoperative mutism in neurosurgery. Report of two cases. J Neurosurg 81:115–121PubMedCrossRefGoogle Scholar
  65. 65.
    Wang MC, Winston KR, Breeze RE (2002) Cerebellar mutism associated with a midbrain cavernous malformation. Case report and review of the literature. J Neurosurg 96:607–610PubMedCrossRefGoogle Scholar
  66. 66.
    Wells EM, Walsh KS, Khademian ZP, Keating RF, Packer RJ (2008) The cerebellar mutism syndrome and its relation to cerebellar cognitive function and the cerebellar cognitive affective disorder. Dev Disabil Res Rev 14:221–228PubMedCrossRefGoogle Scholar
  67. 67.
    Roper A, Brown R (eds) (2005) Adams and Victor’s principles of neurology. McGraw-Hill, New YorkGoogle Scholar
  68. 68.
    Granziera C, Schmahmann JD, Hadjikhani N, Meyer H, Meuli R, Wedeen V, Krueger G (2009) Diffusion spectrum imaging shows the structural basis of functional cerebellar circuits in the human cerebellum in vivo. PLoS One 4:e5101PubMedCrossRefGoogle Scholar
  69. 69.
    Schmahmann JD, Pandya DN (2008) Disconnection syndromes of basal ganglia, thalamus, and cerebrocerebellar systems. Cortex 44:1037–1066PubMedCrossRefGoogle Scholar
  70. 70.
    Ammirati M, Mirzai S, Samii M (1989) Transient mutism following removal of a cerebellar tumor. A case report and review of the literature. Childs Nerv Syst 5:12–14PubMedCrossRefGoogle Scholar
  71. 71.
    Asamoto M, Ito H, Suzuki N, Oiwa Y, Saito K, Haraoka J (1994) Transient mutism after posterior fossa surgery. Childs Nerv Syst 10:275–278PubMedCrossRefGoogle Scholar
  72. 72.
    Kusano Y, Tanaka Y, Takasuna H, Wada N, Tada T, Kakizawa Y, Hongo K (2006) Transient cerebellar mutism caused by bilateral damage to the dentate nuclei after the second posterior fossa surgery. Case report. J Neurosurg 104:329–331PubMedCrossRefGoogle Scholar
  73. 73.
    Nagatani K, Waga S, Nakagawa Y (1991) Mutism after removal of a vermian medulloblastoma: cerebellar mutism. Surg Neurol 36:307–309PubMedCrossRefGoogle Scholar
  74. 74.
    Salvati M, Cervoni L, Santoro A (1996) Cerebellar mutism after posterior cranial fossa surgery. J Neurosurg Sci 40:59–63PubMedGoogle Scholar
  75. 75.
    Stein BM, Fraser RA, Tenner MS (1972) Normal pressure hydrocephalus: complication of posterior fossa surgery in children. Pediatrics 49:50–58PubMedGoogle Scholar
  76. 76.
    Catsman-Berrevoets CE, van Dongen HR, Zwetsloot CP (1992) Transient loss of speech followed by dysarthria after removal of posterior fossa tumour. Dev Med Child Neurol 34:1102–1109PubMedCrossRefGoogle Scholar
  77. 77.
    Caner H, Altinors N, Benli S, Calisaneller T, Albayrak A (1999) Akinetic mutism after fourth ventricle choroid plexus papilloma: treatment with a dopamine agonist. Surg Neurol 51:181–184PubMedCrossRefGoogle Scholar
  78. 78.
    McMillan HJ, Keene DL, Matzinger MA, Vassilyadi M, Nzau M, Ventureyra EC (2009) Brainstem compression: a predictor of postoperative cerebellar mutism. Childs Nerv Syst 25:677–681PubMedCrossRefGoogle Scholar
  79. 79.
    Catsman-Berrevoets CE, van Dongen HR, Aarsen FK, Paquier PF (2003) Transient cerebellar eye closure and mutism after cerebellar tumor surgery: long-term clinical follow-up of neurologic and behavioral disturbances in a 14-year-old girl. Pediatr Neurosurg 38:122–127PubMedCrossRefGoogle Scholar
  80. 80.
    Germano A, Baldari S, Caruso G, Caffo M, Montemagno G, Cardia E, Tomasello F (1998) Reversible cerebral perfusion alterations in children with transient mutism after posterior fossa surgery. Childs Nerv Syst 14:114–119PubMedCrossRefGoogle Scholar
  81. 81.
    van MM, Catsman-Berrevoets CE, van Dongen HR, Neville BG (1997) Complex orofacial movements and the disappearance of cerebellar mutism: report of five cases. Dev Med Child Neurol 39:686–690Google Scholar
  82. 82.
    De Smet HJ, Baillieux H, Wackenier P, De PM, Engelborghs S, Paquier PF, De Deyn PP, Marien P (2009) Long-term cognitive deficits following posterior fossa tumor resection: a neuropsychological and functional neuroimaging follow-up study. Neuropsychology 23:694–704PubMedCrossRefGoogle Scholar
  83. 83.
    Grill J, Viguier D, Kieffer V, Bulteau C, Sainte-Rose C, Hartmann O, Kalifa C, Dellatolas G (2004) Critical risk factors for intellectual impairment in children with posterior fossa tumors: the role of cerebellar damage. J Neurosurg 101:152–158PubMedGoogle Scholar
  84. 84.
    De Smet HJ, Baillieux H, Catsman-Berrevoets C, De Deyn PP, Marien P, Paquier PF (2007) Postoperative motor speech production in children with the syndrome of ‘cerebellar’ mutism and subsequent dysarthria: a critical review of the literature. Eur J Paediatr Neurol 11:193–207PubMedCrossRefGoogle Scholar
  85. 85.
    Levisohn L, Cronin-Golomb A, Schmahmann JD (2000) Neuropsychological consequences of cerebellar tumour resection in children: cerebellar cognitive affective syndrome in a paediatric population. Brain 123(Pt 5):1041–1050PubMedCrossRefGoogle Scholar
  86. 86.
    Scott RB, Stoodley CJ, Anslow P, Paul C, Stein JF, Sugden EM, Mitchell CD (2001) Lateralized cognitive deficits in children following cerebellar lesions. Dev Med Child Neurol 43:685–691PubMedCrossRefGoogle Scholar
  87. 87.
    Ersahin Y (1998) Is splitting of the vermis responsible for cerebellar mutism? Pediatr Neurosurg 28:328PubMedCrossRefGoogle Scholar
  88. 88.
    Nishikawa M, Komiyama M, Sakamoto H, Yasui T, Nakajima H (1998) Cerebellar mutism after basilar artery occlusion—case report. Neurol Med Chir (Tokyo) 38:569–573CrossRefGoogle Scholar
  89. 89.
    Ersahin Y (1998) SPECT in cerebellar mutism. Childs Nerv Syst 14:611–613PubMedCrossRefGoogle Scholar
  90. 90.
    Miller NG, Reddick WE, Kocak M, Glass JO, Lobel U, Morris B, Gajjar A, Patay Z (2010) Cerebellocerebral diaschisis is the likely mechanism of postsurgical posterior fossa syndrome in pediatric patients with midline cerebellar tumors. AJNR Am J Neuroradiol 31:288–294PubMedCrossRefGoogle Scholar
  91. 91.
    Sagiuchi T, Ishii K, Aoki Y, Kan S, Utsuki S, Tanaka R, Fujii K, Hayakawa K (2001) Bilateral crossed cerebello–cerebral diaschisis and mutism after surgery for cerebellar medulloblastoma. Ann Nucl Med 15:157–160PubMedCrossRefGoogle Scholar
  92. 92.
    Van Mourik M, Catsman-Berrevoets CE, van Dongen HR, Neville BG (1997) Complex orofacial movements and the disappearance of cerebellar mutism: report of five cases. Dev Med Child Neurol 39:686–690PubMedCrossRefGoogle Scholar
  93. 93.
    Tan TC, Chiu HM, Chan CM, Leung SCL, Lee MK (1999) Transient mutism following posterior fossa surgery. Ann Coll Surg 20–22Google Scholar
  94. 94.
    Wisoff JH, Epstein FJ (1984) Pseudobulbar palsy after posterior fossa operation in children. Neurosurgery 15:707–709PubMedCrossRefGoogle Scholar
  95. 95.
    Nandagopal R, Krishnamoorthy SG (2004) Transient mutism due to posterior circulation infarction. Neurol India 52:510–511PubMedGoogle Scholar
  96. 96.
    Frim DM, Ogilvy CS (1995) Mutism and cerebellar dysarthria after brain stem surgery: case report. Neurosurgery 36:854–857PubMedCrossRefGoogle Scholar
  97. 97.
    Wells EM, Khademian ZP, Walsh KS, Vezina G, Sposto R, Keating RF, Packer RJ (2010) Postoperative cerebellar mutism syndrome following treatment of medulloblastoma: neuroradiographic features and origin. J Neurosurg Pediatr 5:329–334PubMedCrossRefGoogle Scholar
  98. 98.
    Dailey AT, McKhann GM, Berger MS (1995) The pathophysiology of oral pharyngeal apraxia and mutism following posterior fossa tumor resection in children. J Neurosurg 83:467–475PubMedCrossRefGoogle Scholar
  99. 99.
    Ozgur BM, Berberian J, Aryan HE, Meltzer HS, Levy ML (2006) The pathophysiologic mechanism of cerebellar mutism. Surg Neurol 66:18–25PubMedCrossRefGoogle Scholar
  100. 100.
    Korah MP, Esiashvili N, Mazewski CM, Hudgins RJ, Tighiouart M, Janss AJ, Schwaibold FP, Crocker IR, Curran WJ Jr, Marcus RB Jr (2010) Incidence, risks, and sequelae of posterior fossa syndrome in pediatric medulloblastoma. Int J Radiat Oncol Biol Phys 77:106–112PubMedCrossRefGoogle Scholar
  101. 101.
    Kai Y, Kuratsu J, Suginohara K, Marubayashi T, Ushio Y (1997) Cerebellar mutism after posterior fossa surgery—two case reports. Neurol Med Chir (Tokyo) 37:929–933CrossRefGoogle Scholar
  102. 102.
    Mussi AC, Rhoton AL Jr (2000) Telovelar approach to the fourth ventricle: microsurgical anatomy. J Neurosurg 92:812–823PubMedCrossRefGoogle Scholar
  103. 103.
    El-Bahy K (2005) Telovelar approach to the fourth ventricle: operative findings and results in 16 cases. Acta Neurochir (Wien) 147:137–142CrossRefGoogle Scholar
  104. 104.
    Rajesh BJ, Rao BR, Menon G, Abraham M, Easwer HV, Nair S (2007) Telovelar approach: technical issues for large fourth ventricle tumors. Childs Nerv Syst 23:555–558PubMedCrossRefGoogle Scholar
  105. 105.
    Deshmukh VR, Figueiredo EG, Deshmukh P, Crawford NR, Preul MC, Spetzler RF (2006) Quantification and comparison of telovelar and transvermian approaches to the fourth ventricle. Neurosurgery 58:ONS-6Google Scholar
  106. 106.
    Tanriover N, Ulm AJ, Rhoton AL Jr, Yasuda A (2004) Comparison of the transvermian and telovelar approaches to the fourth ventricle. J Neurosurg 101:484–498PubMedCrossRefGoogle Scholar
  107. 107.
    von HK, Kieffer V, Habrand JL, Kalifa C, Dellatolas G, Grill J (2008) Impairment of intellectual functions after surgery and posterior fossa irradiation in children with ependymoma is related to age and neurologic complications. BMC Cancer 8:15CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Thora Gudrunardottir
    • 1
  • Astrid Sehested
    • 1
  • Marianne Juhler
    • 2
  • Kjeld Schmiegelow
    • 1
    • 3
  1. 1.Department of PediatricsThe University Hospital RigshospitaletCopenhagenDenmark
  2. 2.Department of NeurosurgeryThe University Hospital RigshospitaletCopenhagenDenmark
  3. 3.The Faculty of Medicine, Institute of Gynecology, Obstetrics and PediatricsUniversity of CopenhagenCopenhagenDenmark

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