Tractografía de la vía dento-rubro-talámica en mutismo cerebeloso postoperatorio en ni?os con tumores de fosa posterior

摘要

Introduction: Cerebellar mutism syndrome refers to the muteness (lack of speech) that follows lesions of the cerebellum. It’s characterized by a late onset, limited duration, and in some caseslong-term language sequelae. Its pathogenesis it s not clear yet, but it has been attributed a roleto a damage of the dentate nucleus and of the dento-rubro-thalamic tract. Objectives: Identifypotential risk factors (clinical or anatomical) to predict the onset of cerebellar mutism afterposterior fossa surgery Compare, using MRI analysis and DTI tractography, the integrity of thedento-rubro-thalamic tract in patients with and without cerebellar mutism. Methods: Prospectivefollow up study of patients operated of posterior fossa tumors between November 2012 and2013. We performed a study with DTI of the dento rubro thalamic tract in pacients with andwithout postoperative mutism. Results: 53 patients under the diagnosis of posterior fossa tumorunderwent surgical resection. 5 pacients presented postoperative mutism (9,4%). There was asignificant association between postoperative medulloblastoma diagnosis and postoperativemutism. Tumor volume was not significant. The volume of left and right dento rubro thalamictract were significantly lower in patients with cerebellar mutism. The fractional anisotropy ofthe right superior cerebellar peduncle was also lower in patients with postoperative mutism.Conclusions: The postoperative cerebellar mutism is a relevant complication after a posteriorfossa surgery. Our study supports the role of dento rubro thalamic tract damage in the pathogenesisof this syndrome. Special care must be taken during surgery to prevent damage to this tract.