Child's Nervous System

, 27:1129 | Cite as

Incidence of mutism, dysarthria and dysphagia associated with childhood posterior fossa tumour

Original Paper



Dysarthria and dysphagia are known complications following posterior fossa tumour (PFT) surgery. Outcome studies for these disorders, however, have focused on a select sub-group of children with mutism. Little is known regarding the incidence or features of these impairments in a consecutively admitted sample of children with PFT. This study describes the incidence and features of mutism, dysarthria and dysphagia during the acute post-surgical phase in a consecutive sample of children with PFT, unselected for the presence of mutism.


A retrospective medical chart review of children aged 2 to 18 years consecutively admitted with PFT between January 2003 and January 2008 was conducted.


Twenty-seven children with PFT were identified. Post-surgical mutism, dysarthria and dysphagia were recorded in 9/27 (33%), 8/27 (30%) and 9/27 (33%) cases, respectively. Dysarthria most commonly involved deficits in articulation; however, impairments in respiration, phonation and prosody were also reported. Dysphagia involved all stages of swallowing (i.e., pre-oral anticipatory, oral preparatory, oral and pharyngeal). Eighty-nine percent of children (8/9) presented with dysphagia at hospital discharge.


The incidence of acute presentation of mutism, dysarthria and dysphagia post-surgery was relatively high, affecting around one in three cases. This incidence rate, considered together with the fact that over half of all cases had co-morbid communication or swallowing impairments, suggests that health professionals should be aware of the likelihood of dysarthria and dysphagia presentation in the acute period and consider speech pathology referral where necessary.


Posterior fossa tumour Paediatric Mutism Speech Dysarthria Swallowing Dysphagia 


  1. 1.
    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(2):132–138PubMedCrossRefGoogle Scholar
  2. 2.
    Ackermann H (2008) Cerebellar contributions to speech production and speech perception: psycholinguistic and neurobiological perspectives. Trends Neurosci 31(6):265–272PubMedCrossRefGoogle Scholar
  3. 3.
    Riecker A, Mathiak K, Wildgruber D, Erb M, Hertrich I, Grodd W, Ackermann H (2005) fMRI reveals two distinct cerebral networks subserving speech motor control. Neurology 64(4):700–706PubMedGoogle Scholar
  4. 4.
    Humbert IA, Robbins J (2007) Normal swallowing and functional magnetic resonance imaging: a systematic review. Dysphagia 22(3):266–275PubMedCrossRefGoogle Scholar
  5. 5.
    De Smet HJ, Baillieux H, Catsman-Berrevoets C, De Deyn PP, Mariën 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(4):193–207PubMedCrossRefGoogle Scholar
  6. 6.
    Pollack IF, Polinko P, Albright L, Towbin R, Fitz C (1995) Mutism and pseudobulbar symptoms after resection of posterior fossa tumors in children: incidence and pathophysiology. Neurosurgery 37(5):885–893PubMedCrossRefGoogle Scholar
  7. 7.
    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(11):3087–3095PubMedCrossRefGoogle Scholar
  8. 8.
    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(4):329–332PubMedCrossRefGoogle Scholar
  9. 9.
    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(3):467–475PubMedCrossRefGoogle Scholar
  10. 10.
    Pollack IF (2001) Neurobehavioral abnormalities after posterior fossa surgery in children. Int Rev Psychiatry 13(4):302–312CrossRefGoogle Scholar
  11. 11.
    Kingma A, Mooij JJA, Metzemaekers JDM, Leeuw JA (1994) Transient mutism and speech disorders after posterior fossa surgery in children with brain tumours. Acta Neurochir 131(1–2):74–89CrossRefGoogle Scholar
  12. 12.
    Aarsen FK, Van Dongen HR, Paquier PF, Van Mourik M, Catsman-Berrevoets CE (2004) Long-term sequelae in children after cerebellar astrocytoma surgery. Neurology 62(8):1311–1316PubMedGoogle Scholar
  13. 13.
    Richter S, Schoch B, Ozimek A, Gorissen B, Hein-Kropp C, Kaiser O, Hovel M, Wieland R, Gizewski E, Ziegler W, Timmann D (2004) Incidence of dysarthria in children with cerebellar tumors: a prospective study. Brain Lang 92(2):153–167CrossRefGoogle Scholar
  14. 14.
    Newman LA, Boop FA, Sandford RA, Thompson JW, Temple CK, Duntsch CD (2006) Postoperative swallowing function after posterior fossa tumour resection in pediatric patients. Childs Nerv Syst 22(10):1296–1300PubMedCrossRefGoogle Scholar
  15. 15.
    Morgan AT, Sell D, Ryan M, Raynsford E, Hayward R (2008) Pre and post-surgical dysphagia outcome associated with posterior fossa tumour in children. J Neurooncol 87(3):347–354PubMedCrossRefGoogle Scholar
  16. 16.
    Arvedson J, Rogers B, Buck G, Smart P, Msall M (1994) Silent aspiration prominent in children with dysphagia. Int J Pediatr Otorhinolaryngol 28(1–2):173–181PubMedCrossRefGoogle Scholar
  17. 17.
    Bhatoe HS (1997) Mutism, oropharyngeal apraxia and dysarthria after posterior fossa tumour excision. Br J Neurosurg 11(4):341–343PubMedCrossRefGoogle Scholar
  18. 18.
    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(6):444–451PubMedGoogle Scholar
  19. 19.
    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(4):179–183PubMedCrossRefGoogle Scholar
  20. 20.
    Cornwell PL, Murdoch BE, Ward EC, Morgan A (2003) Dysarthria and dysphagia as long-term sequelae in a child treated for posterior fossa tumour. Pediatr Rehabil 6(2):67–75PubMedGoogle Scholar
  21. 21.
    Murdoch BE, Hudson-Tennent LJ (1994) Speech disorders in children treated for posterior fossa tumours: ataxic and developmental features. Eur J Disord Commun 29(4):379–397PubMedCrossRefGoogle Scholar
  22. 22.
    Leitão S, Fletcher J (2004) Literacy outcomes for students with speech impairment: long-term follow-up. Int J Lang Commun Disord 39(2):245–256PubMedCrossRefGoogle Scholar
  23. 23.
    Lewis BA, Freebairn LA, Taylor HG (2000) Academic outcomes in children with histories of speech sound disorders. J Commun Disord 33(1):11–30PubMedCrossRefGoogle Scholar
  24. 24.
    Sheikh S, Allen E, Shell R, Hruschak J, Iram D, Castile R, McCoy K (2001) Chronic aspiration without gastroesophageal reflux as a cause of chronic respiratory symptoms in neurologically normal infants. Chest 120(4):1190–1195PubMedCrossRefGoogle Scholar
  25. 25.
    Nip ISB, Green JR, Marx DB (2009) Early speech motor development: cognitive and linguistic considerations. J Commun Disord 42(4):286–298PubMedCrossRefGoogle Scholar
  26. 26.
    Carruth BR, Skinner JD (2002) Feeding behaviors and other motor development in healthy children (2–24 Months). J Am Coll Nutr 21(2):88–96PubMedGoogle Scholar
  27. 27.
    Catsman-Berrevoets CE, Van Dongen HR, Mulder PGH, Paz y 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(6):755–757PubMedCrossRefGoogle Scholar
  28. 28.
    David KM, Casey AT, Hayward RD, Harkness WF, Phipps K, Wade AM (1997) Medulloblastoma: is the 5-year survival rate improving? A review of 80 cases from a single institution. J Neurosurg 86(1):13–21PubMedCrossRefGoogle Scholar
  29. 29.
    Dubey A, Sung WS, Shaya M, Patwardhan R, Willis B, Smith D, Nanda A (2009) Complications of posterior cranial fossa surgery - an institutional experience of 500 patients. Surg Neurol 72(4):369–375PubMedCrossRefGoogle Scholar
  30. 30.
    Kotil K, Eras M, Akcetin M, Bilge T (2008) Cerebellar mutism following posterior fossa tumor resection in children. Turk Neurosurg 18(1):89–94PubMedGoogle Scholar
  31. 31.
    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(8):963–972PubMedCrossRefGoogle Scholar
  32. 32.
    Di Rocco C, Chieffo D, Pettorini BL, Massimi L, Caldarelli M, Tamburrini G (2010) Preoperative and postoperative neurological, neuropsychological and behavioral impairment in children with posterior cranial fossa astrocytomas and medulloblastomas: the role of the tumor and the impact of the surgical treatment. Childs Nerv Syst 26:1173–1188PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  1. 1.Healthy Development ThemeMurdoch Childrens Research InstituteMelbourneAustralia
  2. 2.Critical Care Neurosciences ThemeMurdoch Childrens Research InstituteMelbourneAustralia
  3. 3.Department of PaediatricsUniversity of MelbourneMelbourneAustralia
  4. 4.Speech Pathology DepartmentRoyal Children’s HospitalMelbourneAustralia

Personalised recommendations