Mutism after posterior fossa tumour resection in children: incomplete recovery on long-term follow-up.
BACKGROUND
Mutism after posterior fossa tumour resection is generally said to be transient. Our experience suggested that speech did not usually normalise, and that mutism was associated with neurologic deficits that did not recover fully.


METHODS
Children with mutism after posterior fossa tumour resection, and alive more than 2 years post-operatively, were reviewed retrospectively. Charts were reviewed and parents contacted to ascertain details about mutism, associated neurologic deficits, and the most recent speech and neurologic status.


RESULTS
There were 7 children, with follow-up ranging from 2.5 to 13.1 years (mean 6.8 years). Tumours were midline, with 4 astrocytomas and 3 medulloblastomas. Mutism was noted immediately after post-operative extubation in all patients. Speech reappeared 1-15 weeks post-operatively, except for 1 patient, who remained mute at 2.5 years. Speech returned to normal in only 1 patient. Mutism was always accompanied by new or worsened cerebellar ataxia, which resolved incompletely in the long term. Sixth nerve palsies occurred in 3 and recovered incompletely. Seventh nerve paresis occurred in 2 and recovered completely.


CONCLUSIONS
Mutism after posterior fossa tumour resection is associated with other neurologic deficits, particularly ataxia. Whereas speech usually returns, contrary to general opinion, speech rarely normalises. Other associated deficits rarely resolve completely. These findings have significant implications for counselling of family and patients.
Steinbok
Paul
P
Division of Paediatric Neurosurgery, British Columbia's Children Hospital, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada. psteinbok@cw.bc.ca
Cochrane
D Douglas
DD
Perrin
Richard
R
Price
Angela
A
D000293:Adolescent; D001254:Astrocytoma / Q000150:complications* / Q000503:physiopathology / Q000601:surgery*; D001259:Ataxia / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015192:Infratentorial Neoplasms / Q000150:complications* / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008527:Medulloblastoma / Q000150:complications* / Q000503:physiopathology / Q000601:surgery*; D009155:Mutism / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D011183:Postoperative Complications; D020127:Recovery of Function / Q000502:physiology*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors