title: Clinical and methodological confounders in assessing the cerebellar cognitive affective syndrome in adult patients with posterior fossa tumours.
abstract: The cerebellar cognitive affective syndrome (CCAS) was first described by Schmahmann and Sherman as a constellation of symptoms including dysexecutive syndrome, spatial cognitive deficit, linguistic deficits and behavioural abnormalities in patients with a lesion in the cerebellum with otherwise normal brain. Neurosurgical patients with cerebellar tumours constitute one of the cohorts in which the CCAS has been described. In this paper, we present a critical review of the literature of this syndrome in neurosurgical patients. Thereafter, we present a prospective clinical study of 10 patients who underwent posterior fossa tumour resection and had a detailed post-operative neuropsychological, neuropsychiatric and neuroradiological assessment. Because our findings revealed a large number of perioperative neuroradiological confounding variables, we reviewed the neuroimaging of a further 20 patients to determine their prevalence. Our literature review revealed that study design, methodological quality and sometimes both diagnostic criteria and findings were inconsistent. The neuroimaging study (pre-operative, n = 10; post-operative, n = 10) showed very frequent neuroradiological confounding complications (e.g. hydrocephalus; brainstem compression; supratentorial lesions and post-operative subdural hygroma); the impact of such features had largely been ignored in the literature. Findings from our clinical study showed various degree of deficits in neuropsychological testing (n = 1, memory; n = 3, verbal fluency; n = 3, attention; n = 2, spatial cognition deficits; and n = 1, behavioural changes), but no patient had full-blown features of CCAS. Our study, although limited, finds no robust evidence of the CCAS following surgery. This and our literature review highlight a need for guidelines regarding study design and methodology when attempting to evaluate neurosurgical cases with regard to the potential CCAS.
authors.affiliation: School of Medicine, University of Sulaimani , Sulaimani , Iraq.
authors.forename: Dashne
authors.initials: D
authors.lastname: Omar
authors.forename: Tracy
authors.initials: T
authors.lastname: Ryan
authors.forename: Alan
authors.initials: A
authors.lastname: Carson
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Bak
authors.forename: Lorna
authors.initials: L
authors.lastname: Torrens
authors.forename: Ian
authors.initials: I
authors.lastname: Whittle
mesh_terms: D000328:Adult; D000368:Aged; D002526:Cerebellar Diseases / Q000175:diagnosis* / Q000209:etiology; D003072:Cognition Disorders / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015192:Infratentorial Neoplasms / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis* / Q000209:etiology; D055815:Young Adult
keywords: adult; cerebellar tumour; cognitive function; posterior fossa tumour; surgery