TRANSIENT MUTISM FOLLOWING A POSTERIOR-FOSSA APPROACH TO CEREBELLAR TUMORS IN CHILDREN - A CRITICAL-REVIEW OF THE LITERATURE

Transient mutism has been known as a rare complication following a pos terior fossa approach to cerebellar tumors and its cause has not been clearly elucidated. The cerebellar mutism is not accompanied by crania l nerve deficits and disorders of consciousness. Since 1985 only 23 ca ses of mutism following removal of a cerebellar tumor in children have been reported in the literature. Two additional cases have been opera ted upon in our department. Extensive injury to the vermian and parave rmian cerebellar area, involving the hemispheric cortex, cerebellar pe duncles, fibers from the dentato-thalamo-cortical pathway, and dentate and interpositum nuclei may be the most important anatomical substrat e of mutism. The mechanism of such transient mutism seems to be a comp lex of two or more factors (vascular disturbances due to manipulation or retraction of the cerebellar region around the IV ventricle and emo tional factors). On the basis of these 25 cases the major features of the cerebellar mutism are discussed.