Erdal Reşit YILMAZ, BORA GÜRER, Metin ŞANLI, Habibullah DOLGUN, ZEKİ ŞEKERCİ

Posterior fossa cerrahisi sonrası ortaya çıkan serebellar mutizm: Olgu sunumu

Cerebellar mutism is an entity, almost always seen in the childhood after posterior fossa surgey and is not associated with cerebellar hemorrage, infection, degeneration and neoplastic diseases. Disruption of speech in cerebellar mutism is usually temporary but some permanent cases may occur. Mutism mostly disappears in six months period. During surgery, injury to cerebellar nucleus and vermis and vascular spasm have been accused but the etiology is not clear. For correct diagnosis and treatment of such disease, a close cooperation between neurosurgeon and pediatrician is needed. We present a case of childhood cerebellar mutism after posterior fossa surgery.

Cerebellar mutism after posterior fossa surgery: Case report

Serebellar mutizm çoğunlukla çocuk hasta grubunda görülen, serebellar kanama, enfeksiyon, serebellumun dejeneratif veya neoplastik hastalıklarıyla ilişkili olmayan, posterior fossa cerrahisi sonrasında konuşma yeteneğinin geçici olarak veya tümüyle kaybedilmesi ile karakterize bir durumdur. Bu durum genelde 6 aylık bir zaman içerisinde düzelme göstermektedir. Etyolojisi bilinmemekle beraber cerrahi sonrası serebellar nukleusların, vermisin hasar görmesi, vasküler spazm gelişmesi bu hasarın oluşumunda rol oynamaktadır. Bu hastalık cerrahların ve pediatristlerin yakın işbirliğini gerektirmektedir. Bu olgumuzda çocukluk çağında tümör cerrahisi sonrası gelişen serebellar mutizm olgusu literatür ışığında incelenmiştir.

PDF

___

1) Kotil K, Eras M, Akçetin M, Bilge T. Cerebellar mutism following posterior fossa tumor resection in children. Turk Neurosurg. 2008; 18: 89-94.

2) Siffert J, Pousssaint TY, Goumnerova LC, Scott RM, LaValley B, Tarbell NJ, Pomeroy SL. Neurological dysfunction associated with postoperative cerebellar mutism. J Neurooncol. 2000; 48: 75-81.

3) Doxey D, Bruce D, Sklar F, Swift D, Shapiro K. Posterior fossa syndrome: identifiable risk factors and irreversible complications. Pediatr Neurosurg. 1999; 31: 131-136.

4) Wolfe-Christensen C, Mullins LL, Scott JG, McNall-Knapp RY. Persistent psychosocial problems in children who develop posterior fossa syndrome after medulloblastoma resection. Pedi-atr Blood Cancer. 2007; 49: 723-726.

5) De Smet HJ, Baillieux H, Catsman-Berrevoets C, De Deyn PP, Mariën P, Paquier PF. Postoperative motor speech production in children with the syndrome of 'cerebellar' mutism and subsequent dysarthria: a critical review of the literature. Eur J Paediatr Neurol. 2007; 11: 193-207.

6) Kusano Y, Tanaka Y, Takasuna H, Wada N, Tada T, Kakizawa Y, Hongo K: Transient cerebellar mutism caused by bilateral damage to the dentate nuclei after the second posterior fossa surgery, Case report. J Neurosurg. 2006; 104: 329-331.

7) Dietze DD Jr, Mickle JP. Cerebellar mutism after posterior fossa surgery. Pediatr Neurosurg. 1990-1991; 16: 25-31. Discussion 31.

8) Ozgur BM, Berberian J, Aryan HE, Meltzer HS, Levy ML. The pathophysiologic mechanism of cerebellar mutism. Surg Neurol. 2006; 66: 18-25.

9) Catsman-Berrevoets CE, Van Dongen HR, Mulder PG, Paz Geuze D, Paquier PF, Lequin MH. Tumour type and size are high risk factors for the syndrome of "cerebellar" mutism and subsequent dysarthria. J Neurol Neurosurg Psychiatry. 1999; 67: 755-757.

10) Pollack IF, Polinko P, Albright A, Towbin R, Fitz C: Mutism and pseudobulbar symptoms after resection of posterior fossa tumors in children: incidence and pathophysiology. Neurosurgery. 1995; 37: 885-893.

11) Erşahin Y, Mutluer S, Çağli S, Duman Y: Cerebellar mutism :report of seven cases and review of the literature. Neurosurgery. 1996; 28: 60-66.

12) Crutchfield JS, Sawaya R, Meyers CA, Moore BD: postoperative mutism in neurosurgery. Report of two cases. J Neurosurg 1994; 81: 115-121.

13) Van Mourik M, Van Dongen HR, Catsman- Berrevoets CE: The many faces of acquired neurological mutism in childhood. Pedi-atr Neuro 1996; l 15: 352-357.

14) Rekate H, Grubb RL, Aram DM, Hahn JF, Ratcheson RA: Muteness of cerebellar orijin. Arch Neurol 1985; 42: 97-698.

15) Yonemasu Y: Cerebellar mutism and speech disturbance as a complication of posterior fossa surgery in children.13 th Annual Meeting of the Japanese Society for Pediatr Neurosurg, 1985.

16) Kabataş S, Yıldız Ö, Yılmaz C, Altınörs MN: Arka çukur cerrahisi sonrasında çocuklarda serebellar mutizm: literatürün gözden geçirilmesi. Türk Nöroşirürji Dergisi. Cilt: 18; 2008; 3: 155-161.

17) Catsman-Berrevoets CE, Van Dongen HR, Mulder PG, Pazy Geuze D, Paquier PF, Lequin MH: Tumor type and size are high risk factors for the syndrome of ‘'cerebellar'' mutism and subsequent dysarthria. J Neurol Neurosurg Psychiatry 1999; 67: 755-757.

18) Huber JF, Bradley K, Spiegler BJ, Dennis M: Long-term effects of transient cerebellar mutism after cerebellar astrocytoma or medulloblastoma resection in childhood. Childs Nerv Syst 2006; 22: 132-138.