title: Fronto-cerebellar fiber tractography in pediatric patients following posterior fossa tumor surgery.
abstract: OBJECTIVE
  Fronto-cerebellar association fibers (FCF) are involved in neurocognitive regulatory circuitry. This may also be relevant for cerebellar mutism syndrome (CMS) as a complication following posterior fossa tumor removal in children. In the present study, we investigated FCF by diffusion tensor imaging in affected children and controls.
  
  
  METHODS
  Diffusion-weighted MR imaging at 3 T (GE) allowed tractography of FCF using a fiber tracking algorithm software (Brainlab 2.6) in 29 patients after posterior fossa tumor removal and in 10 healthy peers. Fiber tract volumes were assessed and fiber signals were evaluated in a semiquantitative manner along the anatomical course.
  
  
  RESULTS
  Volumes of FCF revealed significant diminished values in pediatric patients with symptoms of CMS (19.3 ± 11.7 cm(3)) when compared with patients without symptoms of CMS (26.9 ± 11.9 cm(3)) and with healthy peers (36.5 ± 13.82 cm(3)). In medulloblastoma patients, the volume of FCF was also significantly reduced in patients with symptoms of CMS despite having the same antitumor therapy. In semiquantitative analysis of the fiber tract signals, differences were observed in the superior cerebellar peduncles and midline cerebellar structures in patients with symptoms of CMS.
  
  
  CONCLUSIONS
  Using DTI, which allows the visualization of fronto-cerebellar fiber tracts, lower FCF tract volumes and diminished fiber signal intensities at the level of the superior cerebellar peduncles and in midline cerebellar structures were identified in patients with postoperative symptoms of CMS. Our study refers to the role of a neural circuitry between frontal lobes and the cerebellum being involved in neurocognitive impairment after posterior fossa tumor treatment in children.
authors.affiliation: Arbeitsbereich Pädiatrische Neurochirurgie, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany.
authors.forename: Verena
authors.initials: V
authors.lastname: Soelva
authors.forename: Pablo
authors.initials: P
authors.lastname: Hernáiz Driever
authors.forename: Alexander
authors.initials: A
authors.lastname: Abbushi
authors.forename: Stefan
authors.initials: S
authors.lastname: Rueckriegel
authors.forename: Harald
authors.initials: H
authors.lastname: Bruhn
authors.forename: Wilhelm
authors.initials: W
authors.lastname: Eisner
authors.forename: Ulrich-Wilhelm
authors.initials: UW
authors.lastname: Thomale
mesh_terms: D000293:Adolescent; D002531:Cerebellum / Q000473:pathology* / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D003388:Cranial Fossa, Posterior / Q000601:surgery; D003430:Cross-Sectional Studies; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D005625:Frontal Lobe / Q000473:pathology* / Q000601:surgery; D006801:Humans; D008297:Male; D008527:Medulloblastoma / Q000473:pathology / Q000601:surgery; D009155:Mutism / Q000209:etiology / Q000473:pathology*; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D019292:Skull Base Neoplasms / Q000473:pathology / Q000601:surgery