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Toescu SM, Hales PW, Cooper J, Dyson EW, Mankad K, Clayden JD, Aquilina K, Clark CA. Arterial Spin-Labeling Perfusion Metrics in Pediatric Posterior Fossa Tumor Surgery. AJNR Am J Neuroradiol 2022; 43:1508-1515. [PMID: 36137658 PMCID: PMC9575521 DOI: 10.3174/ajnr.a7637] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 07/27/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND PURPOSE Pediatric posterior fossa tumors often present with hydrocephalus; postoperatively, up to 25% of patients develop cerebellar mutism syndrome. Arterial spin-labeling is a noninvasive means of quantifying CBF and bolus arrival time. The aim of this study was to investigate how changes in perfusion metrics in children with posterior fossa tumors are modulated by cerebellar mutism syndrome and hydrocephalus requiring pre-resection CSF diversion. MATERIALS AND METHODS Forty-four patients were prospectively scanned at 3 time points (preoperatively, postoperatively, and at 3-month follow-up) with single- and multi-inflow time arterial spin-labeling sequences. Regional analyses of CBF and bolus arrival time were conducted using coregistered anatomic parcellations. ANOVA and multivariable, linear mixed-effects modeling analysis approaches were used. The study was registered at clinicaltrials.gov (NCT03471026). RESULTS CBF increased after tumor resection and at follow-up scanning (P = .045). Bolus arrival time decreased after tumor resection and at follow-up scanning (P = .018). Bolus arrival time was prolonged (P = .058) following the midline approach, compared with cerebellar hemispheric surgical approaches to posterior fossa tumors. Multivariable linear mixed-effects modeling showed that regional perfusion changes were more pronounced in the 6 children who presented with symptomatic obstructive hydrocephalus requiring pre-resection CSF diversion, with hydrocephalus lowering the baseline mean CBF by 20.5 (standard error, 6.27) mL/100g/min. Children diagnosed with cerebellar mutism syndrome (8/44, 18.2%) had significantly higher CBF at follow-up imaging than those who were not (P = .040), but no differences in pre- or postoperative perfusion parameters were seen. CONCLUSIONS Multi-inflow time arterial spin-labeling shows promise as a noninvasive tool to evaluate cerebral perfusion in the setting of pediatric obstructive hydrocephalus and demonstrates increased CBF following resolution of cerebellar mutism syndrome.
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Affiliation(s)
- S M Toescu
- From the Departments of Neurosurgery (S.M.T., E.W.D., K.A.)
- Developmental Imaging and Biophysics Section (S.M.T., P.W.H., J.D.C.), University College London Great Ormond Street Institute of Child Health, London, UK
| | - P W Hales
- Developmental Imaging and Biophysics Section (S.M.T., P.W.H., J.D.C.), University College London Great Ormond Street Institute of Child Health, London, UK
| | - J Cooper
- Neuroradiology (J.C., K.M., C.A.C.), Great Ormond Street Hospital, London, UK
| | - E W Dyson
- From the Departments of Neurosurgery (S.M.T., E.W.D., K.A.)
| | - K Mankad
- Neuroradiology (J.C., K.M., C.A.C.), Great Ormond Street Hospital, London, UK
| | - J D Clayden
- Developmental Imaging and Biophysics Section (S.M.T., P.W.H., J.D.C.), University College London Great Ormond Street Institute of Child Health, London, UK
| | - K Aquilina
- From the Departments of Neurosurgery (S.M.T., E.W.D., K.A.)
| | - C A Clark
- Neuroradiology (J.C., K.M., C.A.C.), Great Ormond Street Hospital, London, UK
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Boisgontier J, Fillon L, Rutten C, Saitovitch A, Dufour C, Lemaître H, Beccaria K, Blauwblomme T, Levy R, Dangouloff-Ros V, Grévent D, Roux CJ, Grill J, Vinçon-Leite A, Saidoun L, Bourdeaut F, Zilbovicius M, Boddaert N, Puget S. A CBF decrease in the left supplementary motor areas: New insight into postoperative pediatric cerebellar mutism syndrome using arterial spin labeling perfusion MRI. J Cereb Blood Flow Metab 2021; 41:3339-3349. [PMID: 34259072 PMCID: PMC8669281 DOI: 10.1177/0271678x211031321] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Postoperative pediatric cerebellar mutism syndrome (pCMS), characterized mainly by delayed onset transient mutism is a poorly understood complication that may occur after pediatric medulloblastoma (MB) resection. Our aim was to investigate postoperative changes in whole-brain cerebral blood flow (CBF) at rest in pCMS patients using arterial spin labeling (ASL) perfusion imaging. This study compared preoperative and postoperative T2-weighted signal abnormalities and CBF using a voxel-wise, whole-brain analysis in 27 children undergoing MB resection, including 11 patients who developed mutism and 16 who did not. Comparison of postoperative T2 signal abnormalities between patients who developed pCMS (mean age 7.0 years) and those who did not showed that pCMS (mean age 8.9 years) patients were significantly more likely to present with T2-weighted hyperintensities in the right dentate nucleus (DN) (p = 0.02). Comparison of preoperative and postoperative CBF in patients with pCMS showed a significant postoperative CBF decrease in the left pre-supplementary motor area (pre-SMA) (p = 0.007) and SMA (p = 0.009). In patients who did not develop pCMS, no significant differences were observed. Findings provide evidence of an association between pCMS, injury to the right DN, and left pre-SMA/SMA hypoperfusion, areas responsible for speech. This supports the relevance of CBF investigations in pCMS.
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Affiliation(s)
- Jennifer Boisgontier
- Paediatric Radiology Department, AP-HP, Hôpital Necker-Enfants Malades, Université de Paris, Paris, France.,Université de Paris, Institut Imagine INSERM U1163, Paris, France
| | - Ludovic Fillon
- Université de Paris, Institut Imagine INSERM U1163, Paris, France
| | - Caroline Rutten
- Paediatric Radiology Department, AP-HP, Hôpital Necker-Enfants Malades, Université de Paris, Paris, France
| | - Ana Saitovitch
- Université de Paris, Institut Imagine INSERM U1163, Paris, France
| | - Christelle Dufour
- Peadiatric and Adolescent Oncology, Institut Gustave Roussy, Villejuif, France
| | - Hervé Lemaître
- Neurofunctional Imaging Group (GIN), Neurodegenerative Diseases Institute, UMR 5293, Bordeaux University, Bordeaux, France
| | - Kévin Beccaria
- Paediatric Neurosurgery Department, AP-HP, Hôpital Necker-Enfants Malades, Université de Paris, Paris, France
| | - Thomas Blauwblomme
- Paediatric Neurosurgery Department, AP-HP, Hôpital Necker-Enfants Malades, Université de Paris, Paris, France
| | - Raphaël Levy
- Paediatric Radiology Department, AP-HP, Hôpital Necker-Enfants Malades, Université de Paris, Paris, France
| | - Volodia Dangouloff-Ros
- Paediatric Radiology Department, AP-HP, Hôpital Necker-Enfants Malades, Université de Paris, Paris, France.,Université de Paris, Institut Imagine INSERM U1163, Paris, France
| | - David Grévent
- Paediatric Radiology Department, AP-HP, Hôpital Necker-Enfants Malades, Université de Paris, Paris, France.,Université de Paris, Institut Imagine INSERM U1163, Paris, France
| | - Charles-Joris Roux
- Paediatric Radiology Department, AP-HP, Hôpital Necker-Enfants Malades, Université de Paris, Paris, France
| | - Jacques Grill
- Peadiatric and Adolescent Oncology, Institut Gustave Roussy, Villejuif, France
| | | | - Lila Saidoun
- Peadiatric and Adolescent Oncology, Institut Gustave Roussy, Villejuif, France
| | - Franck Bourdeaut
- SIREDO Pediatric Oncology Center, Institut Curie, Paris-Science Lettres University, Paris, France
| | - Monica Zilbovicius
- Université de Paris, Institut Imagine INSERM U1163, Paris, France.,INSERM ERL "Developmental Trajectories & Psychiatry": Université Paris Saclay, Ecole Normale Supérieure Paris-Saclay, Université de Paris, CNRS, Centre Borelli, Paris, France
| | - Nathalie Boddaert
- Paediatric Radiology Department, AP-HP, Hôpital Necker-Enfants Malades, Université de Paris, Paris, France.,Université de Paris, Institut Imagine INSERM U1163, Paris, France.,INSERM ERL "Developmental Trajectories & Psychiatry": Université Paris Saclay, Ecole Normale Supérieure Paris-Saclay, Université de Paris, CNRS, Centre Borelli, Paris, France
| | - Stéphanie Puget
- Paediatric Neurosurgery Department, AP-HP, Hôpital Necker-Enfants Malades, Université de Paris, Paris, France
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Ahmadian N, van Baarsen KM, Robe PAJT, Hoving EW. Association between cerebral perfusion and paediatric postoperative cerebellar mutism syndrome after posterior fossa surgery-a systematic review. Childs Nerv Syst 2021; 37:2743-2751. [PMID: 34155533 PMCID: PMC8423702 DOI: 10.1007/s00381-021-05225-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 05/21/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Paediatric postoperative cerebellar mutism syndrome (ppCMS) is a common complication following the resection of a cerebellar tumour in children. It is hypothesized that loss of integrity of the cerebellar output tracts results in a cerebello-cerebral "diaschisis" and reduced function of supratentorial areas of the brain. METHODS We performed a systematic review of the literature according to the PRISMA guidelines, in order to evaluate the evidence for hypoperfusion or hypofunction in the cerebral hemispheres in patients with ppCMS. Articles were selected based on the predefined eligibility criteria and quality assessment. RESULTS Five studies were included, consisting of three prospective cohort studies, one retrospective cohort study and one retrospective case control study. Arterial spin labelling (ASL) perfusion MRI, dynamic susceptibility contrast (DSC) perfusion MRI and single photon emission computed tomography (SPECT) were used to measure the cerebral and cerebellar tissue perfusion or metabolic activity. Reduced cerebral perfusion was predominantly demonstrated in the frontal lobe. CONCLUSIONS This systematic review shows that, after posterior fossa tumour resection, cerebral perfusion is reduced in ppCMS patients compared to patients without ppCMS. Well-powered prospective studies, including preoperative imaging, are needed to ascertain the cause and role of hypoperfusion in the pathophysiology of the syndrome.
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Affiliation(s)
- Narjes Ahmadian
- Department of Neurology and Neurosurgery, Rudolf Magnus Brain Institute, University Medical Center of Utrecht, 100 Heidelberglaan, G03.126, 3584 CX, Utrecht, The Netherlands.
| | - K. M. van Baarsen
- grid.487647.eDepartment of Neurology and Neurosurgery, Princess Maxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands
| | - P. A. J. T. Robe
- grid.7692.a0000000090126352Department of Neurology and Neurosurgery, Rudolf Magnus Brain Institute, University Medical Center of Utrecht, 100 Heidelberglaan, G03.126, 3584 CX Utrecht, The Netherlands
| | - E. W. Hoving
- grid.487647.eDepartment of Pediatric Neurosurgery, Princess Maxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands
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