Longitudinal cerebellar diffusion tensor imaging changes in posterior fossa syndrome.
Posterior fossa syndrome is a severe transient loss of language that frequently complicates resection of tumors of the cerebellum. The associated pathophysiology and relevant anatomy to this language deficit remains controversial. We performed a retrospective analysis of all cerebellar tumor resections at Seattle Children's Hospital from 2010 to 2015. Diffusion tensor imaging was performed on each of the patients as part of their clinical scan. Patients included in the study were divided into groups based on language functioning following resection: intact (N= 19), mild deficit (N= 19), and posterior fossa syndrome (N= 9). Patients with posterior fossa syndrome showed white matter changes evidenced by reductions in fractional anisotropy in the left and right superior cerebellar peduncle following resection, and these changes were still evident 1-year after surgery. These changes were greater in the superior cerebellar peduncle than elsewhere in the cerebellum. Prior to surgery, posterior fossa patients did not show changes in fractional anisotropy however differences were observed in mean and radial diffusivity measures in comparison to other groups which may provide a radiographic marker of those at greatest risk of developing post-operative language loss.
University of Washington, Department of Neurological Surgery, 325 Ninth Avenue, Seattle, WA 98104-2499, USA.
Sean D
SD
McEvoy
University of Washington, Department of Neurological Surgery, 325 Ninth Avenue, Seattle, WA 98104-2499, USA; Seattle Children's Hospital, Division of Neurosurgery, 4800 Sand Point Way NE, Seattle, WA 98105, USA.
Amy
A
Lee
Seattle Children's Hospital, Division of Radiology, 4800 Sand Point Way NE, Seattle, WA 98105, USA.
Andrew
A
Poliakov
Seattle Children's Hospital, Division of Radiology, 4800 Sand Point Way NE, Seattle, WA 98105, USA.
Seth
S
Friedman
Seattle Children's Hospital, Division of Radiology, 4800 Sand Point Way NE, Seattle, WA 98105, USA.
Dennis
D
Shaw
University of Washington, Department of Neurological Surgery, 325 Ninth Avenue, Seattle, WA 98104-2499, USA; Seattle Children's Hospital, Division of Neurosurgery, 4800 Sand Point Way NE, Seattle, WA 98105, USA.
Samuel R
SR
Browd
University of Washington, Department of Neurological Surgery, 325 Ninth Avenue, Seattle, WA 98104-2499, USA; Seattle Children's Hospital, Division of Neurosurgery, 4800 Sand Point Way NE, Seattle, WA 98105, USA.
Richard G
RG
Ellenbogen
University of Washington, Department of Neurological Surgery, 325 Ninth Avenue, Seattle, WA 98104-2499, USA; Seattle Children's Hospital, Division of Neurosurgery, 4800 Sand Point Way NE, Seattle, WA 98105, USA.
Jeffrey G
JG
Ojemann
University of Washington, Department of Neurological Surgery, 325 Ninth Avenue, Seattle, WA 98104-2499, USA.
Christine L
CL
Mac Donald
AD, axial diffusivity; AP, anterior-posterior; CBW, cerebellar white matter; CTC, cerebellar-thalamic-cortical; Cerebellar mutism syndrome (CMS); Diffusion tensor imaging; FA, fractional anisotropy; KW, kruskal-wallis; MCP, middle cerebellar peduncle; MD, mean diffusivity; MPRAGE, Magnetization Prepared Rapid Acquisition Gradient Echo; PFS, posterior fossa syndrome; Posterior fossa syndrome (PFS); RD, radial diffusivity; RESTORE, Robust Estimation of Tensors by Outlier Rejection; SCP, superior cerebellar peduncle; SWI, Susceptibility weighted imaging; TE, echo time; TORTOISE, Tolerably Obsessive Registration and Tensor Optimization Indolent Software Ensemble; TR, relaxation time; Tumor
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