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Post-operative pediatric cerebellar mutism syndrome and its association with hypertrophic olivary degeneration

Avula, S, Spiteri, Michaela, Kumar, R, Lewis, E, Harave, S, Windridge, David, Ong, C and Pizer, B (2016) Post-operative pediatric cerebellar mutism syndrome and its association with hypertrophic olivary degeneration Quantitative Imaging in Medicine and Surgery, 6 (5). pp. 535-544.

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Background: The dentato-thalamo-cortical (DTC) pathway is recognized as the anatomical substrate for postoperative pediatric cerebellar mutism (POPCMS), a well-recognized complication affecting up to 31% of children undergoing posterior fossa brain tumour resection. The proximal structures of the DTC pathway also form a segment of the Guillain and Mollaret triangle, a neural network which when disrupted causes hypertrophic olivary degeneration (HOD) of the inferior olivary nucleus (ION). We hypothesize that there is an association between the occurrence of POPCMS and HOD and aim to evaluate this on MR imaging using qualitative and quantitative analysis of the ION in children with and without POPCMS. Methods: In this retrospective study we qualitatively analysed the follow up MR imaging in 48 children who underwent posterior fossa tumour resection for presence of HOD. Quantitative analysis of the ION was possible in 28 children and was performed using semi-automated segmentation followed by feature extraction and feature selection techniques and relevance of the features to POPCMS were evaluated. The diagnosis of POPCMS was made independently based on clinical and nursing assessment notes. Results: There was significant association between POPCMS and bilateral HOD (P=0.002) but not unilateral HOD. Quantitative analysis showed that hyperintensity in the left ION was the most relevant feature in children with POPCMS. Conclusions: Bilateral HOD can serve as a reliable radiological indicator in establishing the diagnosis of POPCMS particularly in equivocal cases. The strong association of signal change due to HOD in the left ION suggests that injury to the right proximal efferent cerebellar pathway plays an important role in the causation of POPCMS.

Item Type: Article
Divisions : Faculty of Engineering and Physical Sciences > Electronic Engineering > Centre for Vision Speech and Signal Processing
Faculty of Engineering and Physical Sciences > Electronic Engineering
Authors :
Avula, S
Kumar, R
Lewis, E
Harave, S
Ong, C
Pizer, B
Date : September 2016
DOI : 10.21037/qims.2016.10.11
Copyright Disclaimer : © Quantitative Imaging in Medicine and Surgery. All rights reserved.
Uncontrolled Keywords : Cerebellar mutism syndrome (CMS); hypertrophic olivary degeneration; posterior fossa syndrome (PFS); postoperative pediatric cerebellar mutism syndrome
Depositing User : Melanie Hughes
Date Deposited : 26 Jul 2017 10:45
Last Modified : 19 Dec 2019 00:29

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