Adaptive, Behavioral, and Emotional Outcomes Following Postoperative Pediatric Cerebellar Mutism Syndrome in Survivors Treated for Medulloblastoma

Authors

Kimberly P Raghubar
Andrew M Heitzer
Fatema Malbari
Jason Gill
Roy V Sillitoe
Livia Merrill
Johanna Escalante
M Fatih Okcu
Guillermo Aldave
Avner Meoded
Stephen Kralik
Kimberly Davis
Marina Ma
Emily A H Warren
Mark D McCurdy
Howard L Weiner
William Whitehead
Michael E Scheurer
Lisa Rodriguez
Amy Daigle
Murali Chintagumpala
Lisa S Kahalley

Publication Date

6-1-2024

Journal

Journal of Neurosurgery: Pediatrics

DOI

10.3171/2024.1.PEDS23321

PMID

38552237

PMCID

PMC11010724

PubMedCentral® Posted Date

3-29-2024

PubMedCentral® Full Text Version

Post-print

Published Open-Access

yes

Keywords

Humans, Medulloblastoma, Male, Female, Child, Mutism, Cerebellar Neoplasms, Adolescent, Adaptation, Psychological, Emotions, Neuropsychological Tests, Postoperative Complications, Child, Preschool, brain tumor, pediatric, psychosocial, functional outcomes, mutism

Abstract

OBJECTIVE: Patients who experience postoperative pediatric cerebellar mutism syndrome (CMS) during treatment for medulloblastoma have long-term deficits in neurocognitive functioning; however, the consequences on functional or adaptive outcomes are unknown. The purpose of the present study was to compare adaptive, behavioral, and emotional functioning between survivors with and those without a history of CMS.

METHODS: The authors examined outcomes in 45 survivors (15 with CMS and 30 without CMS). Comprehensive neuropsychological evaluations, which included parent-report measures of adaptive, behavioral, and emotional functioning, were completed at a median of 2.90 years following craniospinal irradiation.

RESULTS: Adaptive functioning was significantly worse in the CMS group for practical and general adaptive skills compared with the group without CMS. Rates of impairment in practical, conceptual, and general adaptive skills in the CMS group exceeded expected rates in the general population. Despite having lower overall intellectual functioning, working memory, and processing speed, IQ and related cognitive processes were uncorrelated with adaptive outcomes in the CMS group. No significant group differences or increased rates of impairment were observed for behavioral and emotional outcomes.

CONCLUSIONS: Survivors with CMS, compared with those without CMS, are rated as having significant deficits in overall or general adaptive functioning, with specific weakness in practical skills several years posttreatment. Findings from this study demonstrate the high risk for ongoing functional deficits despite acute recovery from symptoms of CMS, highlighting the need for intervention to mitigate such risk.

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