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

Article

Avula, S., Spiteri, M., Kumar, R., Lewis, E., Harave, S., Windridge, D., 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. https://doi.org/10.21037/qims.2016.10.11
TypeArticle
TitlePost-operative pediatric cerebellar mutism syndrome and its association with hypertrophic olivary degeneration
AuthorsAvula, S., Spiteri, M., Kumar, R., Lewis, E., Harave, S., Windridge, D., Ong, C. and Pizer, B.
Abstract

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.
Keywords: Cerebellar mutism syndrome (CMS); hypertrophic olivary degeneration; posterior fossa syndrome (PFS); postoperative pediatric cerebellar mutism syndrome

KeywordsCerebellar mutism syndrome (CMS); hypertrophic olivary degeneration; posterior fossa syndrome (PFS); postoperative pediatric cerebellar mutism syndrome
PublisherAME Publishing
JournalQuantitative Imaging in Medicine and Surgery
ISSN2223-4292
Electronic2223-4306
Publication dates
PrintOct 2016
Publication process dates
Deposited27 Feb 2018
Accepted10 Oct 2016
Submitted17 Sep 2016
Output statusPublished
Publisher's version
Copyright Statement

© Quantitative Imaging in Medicine and Surgery. All rights reserved. Reproduced here with permission of Quantitative Imaging in Medicine and Surgery

Digital Object Identifier (DOI)https://doi.org/10.21037/qims.2016.10.11
PubMed ID27942473
PubMed Central ID5130563
Web of Science identifierWOS:000391389300008
LanguageEnglish
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Windridge, D. and Bober, M. 2014. A kernel-based framework for medical big-data analytics. in: Interactive Knowledge Discovery and Data Mining in Biomedical Informatics: State-of-the-Art and Future Challenges Springer. pp. 197-208
High throughput screening for mammography using a human-computer interface with rapid serial visual presentation (RSVP)
Abbey, C., Hope, C., Sterr, A., Elangovan, P., Geades, N., Windridge, D., Young, K., Wells, K. and Mello-Thoms, C. 2013. High throughput screening for mammography using a human-computer interface with rapid serial visual presentation (RSVP). SPIE Proceedings Vol. 8673. https://doi.org/10.1117/12.2007557
Looking to score: the dissociation of goal influence on eye movement and meta-attentional allocation in a complex dynamic natural scene
Taya, S., Windridge, D. and Osman, M. 2012. Looking to score: the dissociation of goal influence on eye movement and meta-attentional allocation in a complex dynamic natural scene. PLoS ONE. 7 (6). https://doi.org/10.1371/journal.pone.0039060
Addressing missing values in kernel-based multimodal biometric fusion using neutral point substitution
Poh, N., Windridge, D., Mottl, V., Tatarchuk, A. and Eliseyev, A. 2010. Addressing missing values in kernel-based multimodal biometric fusion using neutral point substitution. IEEE Transactions on Information Forensics and Security. 5 (3), pp. 461-469. https://doi.org/10.1109/TIFS.2010.2053535