Evidence map›Paper›PMID 38279985›Full record

ArticleChild's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery2024

National multicentered retrospective review of clinical and intraoperative factors associated with the development of cerebellar mutism after pediatric posterior fossa tumor resection.

Michelle M Kameda-Smith, Malavan Ragulojan, Cameron Elliott, Lori Bliss, Hanna Moore, Nicholas Sader, Mosaab Alsuwaihel, Michael K Tso, Ayoub Dakson, Olufemi Ajani and 7 more

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In one paragraph

Article in Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed, 1 pooled it
0.8field-weighted citation impact, top 33% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 1 synthesis or guideline pooled it, 3 citations in OpenAlex.

  1. Pooled it
  2. Article
  3. Article
  4. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

17 authors at 6 institutions in 2 countries.

Michelle M Kameda-SmithDivision of Neurosurgery, McMaster University, Hamilton, ON, Canada. michelle.kameda@medportal.ca.
Malavan RagulojanMcMaster Pediatric Brain Tumor Study Group (PBTSG), Hamilton, ON, Canada.
Cameron ElliottCanadian Neurosurgery Research Collaborative (CNRC), Hamilton, Canada.
Lori BlissDivision of Neurosurgery, University of Alberta, Edmonton, AB, Canada.
Hanna MooreDivision of Neurosurgery, University of Alberta, Edmonton, AB, Canada.
Nicholas SaderDivision of Neurosurgery, University of Calgary, Calgary, AB, Canada.
Mosaab AlsuwaihelDivision of Neurosurgery, Dalhousie University, Halifax, NS, Canada.
Michael K TsoCanadian Neurosurgery Research Collaborative (CNRC), Hamilton, Canada.
Ayoub DaksonCanadian Neurosurgery Research Collaborative (CNRC), Hamilton, Canada.
Olufemi AjaniGreat Ormond Street Hospital for Children, London, England.
Blake YarascavitchDivision of Neurosurgery, McMaster University, Hamilton, ON, Canada.
Adam FlemingMcMaster Pediatric Brain Tumor Study Group (PBTSG), Hamilton, ON, Canada.
Vivek MehtaDivision of Neurosurgery, University of Alberta, Edmonton, AB, Canada.
Minoo AminnejadMcMaster Pediatric Brain Tumor Study Group (PBTSG), Hamilton, ON, Canada.
Forough FarrokhyarDivision of Neurosurgery, McMaster University, Hamilton, ON, Canada.
Sheila K SinghDivision of Neurosurgery, McMaster University, Hamilton, ON, Canada.
McMaster Pediatric Brain Tumour Study Group (PBTSG) and the Canadian Neurosurgery Research Collaborative (CNRC)
University of Alberta · CAMcMaster University · CADalhousie University · CAImpact · CAUniversity of Calgary · CAUniversity College London · GB

Funding

Hamilton Health Sciences NIF-17426R Kameda-Smith
6 · The paper itself

Abstract

backgroundCerebellar mutism (CM) is characterized by a significant loss of speech in children following posterior fossa (PF) surgery. The biological origin of CM remains unclear and is the subject of ongoing debate. Significant recovery from CM is less likely than previously described despite rigorous multidisciplinary neuro-rehabilitational efforts.

methodsA national multi-centered retrospective review of all children undergoing PF resection in four midsized Canadian academic pediatric institutions was undertaken. Patient, tumor and surgical factors associated with the post-operative development of CM were reviewed. Retrospective identification of PF surgery patients including those developing and those that did not (internal control).

resultsThe study identified 258 patients across the 4 centers between 2010 and 2020 (mean age 6.73 years; 42.2% female). Overall, CM was experienced in 19.5% of patients (N = 50). Amongst children who developed CM histopathology included medulloblastoma (35.7%), pilocytic astrocytoma (32.6%) and ependymoma (17.1%). Intraoperative impression of adherence to the floor of the 4th ventricle was positive in 36.8%. Intraoperative abrupt changes in blood pressure and/or heart rate were identified in 19.4% and 17.8% of cases. The clinical resolution of CM was rated to be complete, significant resolution, slight improvement, no improvement and deterioration in 56.0%, 8.0%, 20.0%, 14.0% and 2.0%, respectively. In the cohort of children who experienced post-operative CM as compared to their no-CM counterpart, proportionally more tumors were felt to be adherent to the floor of the 4th ventricle (56.0% vs 49.5%), intraoperative extent of resection was a GTR (74% vs 68.8%) and changes in heart rate were noted (≥ 20% from baseline) (26.0% vs 15.9%). However, a multiple regression analysis identified only abrupt changes in HR (OR 5.97, CI (1.53, 23.1), p = 0.01) to be significantly associated with the development of post-operative CM.

conclusionAs a devastating surgical complication after posterior fossa tumor surgery with variable clinical course, identifying and understanding the operative cues and revising intraoperative plans that optimizes the child's neurooncological and clinical outcome are essential.

Indexed as

Cerebellar NeoplasmsInfratentorial NeoplasmsMedulloblastomaMutismCanadaChildFemaleHumansMalePostoperative ComplicationsRetrospective StudiesSyndromeCerebellar mutismCerebellar mutism syndromeMedulloblastomaPediatric posterior fossa surgeryPosterior fossa syndrome

Identifiers

PMID38279985
OpenAlexW4391275911

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.