Cerebellar mutism in children: report of six cases and potential mechanisms.
Cerebellar mutism is a rare finding associated with resection of posterior fossa tumors or cerebellar hemorrhages. We reviewed the medical records of six children, aged 6 to 12 years, who developed cerebellar mutism after resection of a posterior fossa mass or as a result of posterior fossa trauma. From 1989 to 1994, 210 children underwent posterior fossa resection at our institution, and four developed mutism (an incidence of 1.6%). All four patients had primitive neuroectodermal tumors. The fifth patient experienced trauma, and another patient had an arteriovenous malformation (AVM). In four children, hydrocephalus developed as a result of their tumor or AVM. Four developed cerebellar mutism 24 to 48 hours after surgery or trauma, and one developed cerebellar mutism 5 days after surgery, coincident with hydrocephalus. In one, mutism occurred after a second resection was performed for a recurrence of his posterior fossa tumor. Cerebellar mutism lasted 10 days in one patient and 2 to 8 weeks in the other four. Dysarthria was apparent in four patients during the recovery phase. We suggest trauma to the dentate nucleus and/or its outflow tract, the superior cerebellar peduncle, as a cause of reversible mutism. Because posterior fossa tumors are common in children, mutism should be recognized as an important side effect of surgery.
Koh
S
S
Division of Child Neurology, Childrens Hospital Los Angeles, CA 90027, USA.
Turkel
S B
SB
Baram
T Z
TZ
D001924:Brain Concussion / Q000601:surgery*; D002528:Cerebellar Neoplasms / Q000601:surgery*; D002531:Cerebellum / Q000293:injuries*; D002648:Child; D003388:Cranial Fossa, Posterior; D004401:Dysarthria / Q000209:etiology; D006801:Humans; D008499:Medical Records; D009155:Mutism / Q000209:etiology*; D018242:Neuroectodermal Tumors, Primitive / Q000601:surgery*; D011183:Postoperative Complications; D012189:Retrospective Studies