Neurobehavioral abnormalities after posterior fossa surgery in children

At least 10% of children who undergo resection of a cerebellar vermian tumor experience a so-called 'posterior fossa syndrome' that begins 1-6 days postoperatively and gradually resolves over months in most cases. The most common feature of this syndrome is mutism, often referred to as 'cerebellar' mutism. In reality, mutism comprises only one component of a much more complex neurobehavioral symptom complex, which can include oropharyngeal dyspraxia, impaired initiation of complex voluntary movements, oculomotor apraxia, incontinence, emotional lability and bizarre personality changes. In this review, the clinical features, neuroanatomic substrate, possible pathogenic processes, and implications for patient care of this syndrome are reviewed in light of our experience with a large case series of children undergoing resections of cerebellar tumors and other reports in the literature. The evidence from the posterior fossa syndrome support an important role for the cerebellum and/or its afferent and efferent connections in initiating (rather than merely coordinating) speech and other complex motor activities and a potential role for these structures in influencing overall behavior and affective state.