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Pablo Hernáiz Driever, from the Department of Pediatric Oncology, Charité University in Berlin, Germany, drew a cerebellar white matter map of long-term motor cognitive impairment symptoms on neuroimaging images of the child, which showed that damage to the white matter, dentate nucleus and posterior cerebellar lobe of the cerebellum was associated
with long-term cognitive motor impairment.
The results were published online in the August 2021 issue of Child's Nervous System
.
- Excerpted from the article chapter
【Ref: Grosse F, et al.
Childs Nerv Syst.
2021 Sep; 37(9):2787-2797.
doi: 10.
1007/s00381-021-05244-2.
Epub 2021 Aug 5.
】
Research background
Brain tumors in children occur in a significant proportion of the cerebellum; Among them, hair-cell astrocytoma (PA) and medulloblastoma (MB) are the most common tumor types; Total tumor resection is decisive for recurrence-free survival
.
Total resection rates combined with adjuvant therapy significantly improve survival in children
.
At the same time, children with cerebellar tumors may have long-term functional deficits such as cognitive, executive and behavioral abnormalities, which have attracted attention
.
About 11% to 29% of children develop cerebellar mutism syndrome after surgery, mainly characterized by silence and irritability for several days after surgery, accompanied by cerebellar dyskinesia, long bundle signs, and cranial nerve loss
.
Cognitive-emotional deficits
follow.
Cerebellar cognitive affective syndrome (CCAS), including impairment of executive function, visual-spatial cognition, language ability, and emotional regulation, postoperative cerebellar mutism syndrome and CCAS are associated
with damage to the Guillain-Mollaret triangular structure and brain-cerebellar circuit.
Pablo Hernáiz Driever, from the Department of Pediatric Oncology, Charité University in Berlin, Germany, drew a cerebellar white matter map of long-term motor cognitive impairment symptoms on neuroimaging images of the child, which showed that the upper cerebellar foot (SCP) white matter, dentate nucleus, and posterior cerebellar lobe damage were associated
with long-term cognitive motor impairment.
The results were published online in the August 2021 issue of Child's Nervous System
.
Research methods
).
The symptoms of cerebellar lesions were manually mapped on the MRI white matter images of the children and normalized to the Montreal Neurological Institute (MNI) space, and finally the lesion symptom maps were further analyzed
.
Study results
The authors mapped the symptom maps of cognitive and motor deficits in children who survived cerebellar tumors to the structure map of cerebellar white matter, and observed that their cognitive, motor and executive dysfunction were associated
with the superior foot nucleus (SCP), the deep cerebellar nucleus, including the intermediate nucleus (IN), the parietal nucleus (FN), the ventral medial dentate nucleus (DN), and the inferior vermis (VIIIa, VIIIB, IX, X cranial nerves).
Conclusion of the study
The results of this study found that cognitive, motor and executive dysfunction in children with cerebellar tumors are related
to the dentate nucleus, upper feet and lower vermis of the cerebellum.
Therefore, injury to SCP, deep cerebellar nuclei, and brain-cerebellar circuits should be prevented during tumor resection surgery, which is key
to protecting postoperative motor and cognitive function.
Total tumor resection is critical for event-free survival, but often conflicts
with protective motor and cognitive function.
According to the authors, one solution is to use radiological studies using conventional MRI before surgery as well as functional magnetic resonance and DTI imaging to identify children at risk of postoperative cerebellar mutism syndrome and cognitive and motor impairment; Advanced MRI radiology and cerebrospinal fluid biopsy can also improve the accuracy of
preoperative diagnosis.
Together, the above measures facilitate the removal of tumors
without damaging the deep cerebellar nucleus, SCP, and the brain-cerebellar circuit.
