Cerebellar Mutism After Pineal Tumour Excision: A Case Report

Manzil Shrestha,Pushpa Raj Puri,Sameer Aryal,Yam Bahadur Roka

doi:10.3126/jnps.v31i2.4167

Manzil Shrestha, Pushpa Raj Puri + Show 2 more

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https://doi.org/10.3126/jnps.v31i2.4167

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Abstract

Cerebellar mutism syndrome (CMS) was first described by Rekate et al in 1985. This syndrome is a common complication of posterior fossa surgery in children with range of 11-29% and usually manifests as diminished speech, hypotonia, and ataxia. The cause is due to bilateral pertubation of the dentate nuclei and their efferent pathways by edema, perfusional defects, axonal damage or metabolic disturbances. Other rare causes of CMS like acute subdural hematoma of the posterior fossa, head injury, brainstem glioma surgery, meningitis and basilar artery occlusion have also been reported. CMS after supracerebellar resection of the pineal tumor is a very rare with very few cases reported. We report such a case in a 10- year old boy who underwent excision of a pineal tumor through the infratentorial supracerebellar route. Key Words: Cerebellar mutism; hydrocephalus; pineal tumor; posterior fossa. DOI: 10.3126/jnps.v31i2.4167 J Nep Paedtr Soc 2010;31(2):124-126

Highlights

Cerebellar mutism syndrome (CMS) was first described by Rekate et al in 19851. This syndrome is a common complication of posterior fossa surgery in children with range of 11-29% and usually manifests as diminished speech, hypotonia, and ataxia
Patients with medulloblastomas with or without brainstem invasion, midline tumors, large tumor size, length of vermian incision and patients with low socioeconomic status are at a greater risk of developing CMS2,3
Computed tomogram (CT) revealed gross hydrocephalus with an enhancing tumor in the pineal region which was further defined by magnetic resonance imaging (MRI)

Summary

Introduction

Cerebellar mutism syndrome (CMS) was first described by Rekate et al in 19851. This syndrome is a common complication of posterior fossa surgery in children with range of 11-29% and usually manifests as diminished speech, hypotonia, and ataxia. The cause is due to bilateral pertubation of the dentate nuclei and their efferent pathways by edema, perfusional defects, axonal damage or metabolic disturbances. Other rare causes of CMS like acute subdural hematoma of the posterior fossa, head injury, brainstem glioma surgery, meningitis and basilar artery occlusion have been reported[4,5,6].

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Conclusion