VISUAL IMPAIRMENT ASSOCIATED WITH MUTISM AFTER POSTERIOR-FOSSA SURGERY IN CHILDREN

OBJECTIVE: To report four children with visual impairment associated w ith mutism after posterior fossa surgery. Mutism after posterior fossa surgery is a well-described phenomena, but to our knowledge, visual i mpairment has not been reported in association with it. METHODS: Recor d review of four children (age range, 3-7 yr) who underwent posterior fossa surgery (via suboccipital craniotomies) for removal of a medullo blastoma (three patients) or ependymoma (one patient). Each presented with headache, ataxia, or nausea and vomiting, but none had preoperati ve visual complaints other than diplopia. Postoperatively, all patient s were mute, and because of apparent visual loss, neuro-ophthalmic con sultation was requested. Postoperative scans and examinations were als o reviewed. RESULTS: Each child was awake but appeared withdrawn witho ut verbal output. No child blinked to threat or fixed or followed. In each case, pupillary reactivity was normal, and funduscopic examinatio ns revealed only papilledema. One child reached for money. Within week s or months postoperatively, the mutism spontaneously resolved, and vi sual behavior in general improved, roughly in parallel. During the fol low-up period, papilledema resolved and the disc color was normal in e ach case. Magnetic resonance images obtained postoperatively revealed nothing remarkable, except surgical defects, without lesions in the re trogeniculate pathway. CONCLUSION: Impaired visual behavior, mimicking cortical visual loss, may be associated with mutism after posterior f ossa surgery in children. The prognosis for recovery is excellent and parallels the return of normal speech. The mechanism is unclear.