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Introduction:Posterior fossa syndrome (PFS) is characterized by neurobehavioral symptoms,such as eating dysfunction, mood disorders, regressive behavior, apathy, eyelid apraxia, lack of bowel and bladder control, and decreased spontaneous initiation of voluntary activities. PFS and mutism have been documented inapproximately 8-29% of children operated for cerebellar tumor. The aim of this study was to describe the prevalence, clinical features, and outcome inpatients with PFS and/or mutism.                                                                                   Methods: Charts and neuroimages of 178 patients who underwent cerebellar tumor surgery seen between2000-2009 were reviewed. Inclusion criteria: Patients with PFS and/or mutismand normal development before tumor surgery. Results: Thirteen patients (7.3%), 10 males,were included. Mean age at surgery was 6.9 years (range, 1.7-10 years). Primary tumor location: Vermis+hemisphere (56%), cerebellar hemisphere (31%), and vermis (23%). Medulloblastoma, pilocytic astrocytoma, desmoplastic medulloblastoma,and astrocytoma were diagnosed in three patients each, and ependymoma in one.Preoperatively, all had hydrocephalus. Tumor resection was total in 54% and partial in 46%. Post-surgical mutism was observed in 11 (85%) with a mean duration of 54 days (range, 19-130 days) and PFS in nine (associated with mutism in seven). Mean follow-up was 4.6 years. Three patients died because oftumor. Mutism was followed by dysarthria in all. The neurobehavioral symptoms resolved in all cases, but four children required special school.                                                                                                          Conclusion: PFS and mutism are a dramatic clinical event following cerebellar surgery. Although neurobehavioral symptoms and mutism resolved, the neurocognitive outcome was poor.

Posterior fossa syndrome; mutism; cerebellar tumor; children