Abstract
BackgroundThis study was realized thanks to the collaboration of children and adolescents who had been resected from cerebellar tumors. The medulloblastoma group (CE+, n = 7) in addition to surgery received radiation and chemotherapy. The astrocytoma group (CE, n = 13) did not receive additional treatments. Each clinical group was compared in their executive functioning with a paired control group (n = 12). The performances of the clinical groups with respect to controls were compared considering the tumor's localization (vermis or hemisphere) and the affectation (or not) of the dentate nucleus. Executive variables were correlated with the age at surgery, the time between surgery-evaluation and the resected volume.MethodsThe executive functioning was assessed by means of WCST, Complex Rey Figure, Controlled Oral Word Association Test (letter and animal categories), Digits span (WISC-R verbal scale) and Stroop test. These tests are very sensitive to dorsolateral PFC and/or to medial frontal cortex functions. The scores for the non-verbal Raven IQ were also obtained. Direct scores were corrected by age and transformed in standard scores using normative data. The neuropsychological evaluation was made at 3.25 (SD = 2.74) years from surgery in CE group and at 6.47 (SD = 2.77) in CE+ group.ResultsThe Medulloblastoma group showed severe executive deficit (≤ 1.5 SD below normal mean) in all assessed tests, the most severe occurring in vermal patients. The Astrocytoma group also showed executive deficits in digits span, semantic fluency (animal category) and moderate to slight deficit in Stroop (word and colour) tests. In the astrocytoma group, the tumor's localization and dentate affectation showed different profile and level of impairment: moderate to slight for vermal and hemispheric patients respectively. The resected volume, age at surgery and the time between surgery-evaluation correlated with some neuropsychological executive variables.ConclusionResults suggest a differential prefrontal-like deficit due to cerebellar lesions and/or cerebellar-frontal diaschisis, as indicate the results in astrocytoma group (without treatments), that also can be generated and/or increased by treatments in the medulloblastoma group. The need for differential rehabilitation strategies for specific clinical groups is remarked. The results are also discussed in the context of the Cerebellar Cognitive Affective Syndrome.
Highlights
This study was realized thanks to the collaboration of children and adolescents who had been resected from cerebellar tumors
The main tumors appearing in this zone are medulloblastomas, pilocytic astrocytomas and ependymomas, which together include about 90% of the cases
Vermis CE patients compared with norms showed executive deficit in verbal working memory and semantic fluency (-1.2 SD, cut-off 7), moderate impairment in phonologic fluency, and about -0.9 SD below normal mean in the Stroop, conceptual-Wisconsin card sorting test (WCST) and Raven IQ (-1 SD, g IV). These results suggest that these children would present an executive deficit more marked in the language frontal-temporal network and, according to Stroop results, a reduced speed processing
Summary
This study was realized thanks to the collaboration of children and adolescents who had been resected from cerebellar tumors. The medulloblastoma group (CE+, n = 7) in addition to surgery received radiation and chemotherapy. The astrocytoma group (CE, n = 13) did not receive additional treatments. The astrocytoma is the most frequent tumor affecting the posterior fossa in children and in 97% of the cases it corresponds to the pilocytic astrocytoma [1,2]. Treatment must be done through surgical resection and survival can reach more than 90% in 5 years [3,4]. Medulloblastoma is a cerebellar-specific posterior fossa tumor which is very frequent in children. In children over 4 years old, complementary treatment with radiotherapy must be applied to the neuroaxis in order to avoid a possible distant spreading, especially in patients with tumor remains after surgery or in children who present recidiva.
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