A CBF decrease in the left supplementary motor areas: New insight into postoperative pediatric cerebellar mutism syndrome using arterial spin labeling perfusion MRI

Jennifer Boisgontier, Ludovic Fillon, Caroline Rutten, Ana Saitovitch, Christelle Dufour, Hervé Lemaître, Kévin Beccaria, Thomas Blauwblomme, Raphaël Levy, Volodia Dangouloff-Ros, David Grévent, Charles Joris Roux, Jacques Grill, Alice Vinçon-Leite, Lila Saidoun, Franck Bourdeaut, Monica Zilbovicius, Nathalie Boddaert, Stéphanie Puget

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    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.

    Original languageEnglish
    Pages (from-to)3339-3349
    Number of pages11
    JournalJournal of Cerebral Blood Flow and Metabolism
    Volume41
    Issue number12
    DOIs
    Publication statusPublished - 1 Dec 2021

    Keywords

    • Arterial spin labeling
    • cerebral blood flow
    • mutism
    • pediatric
    • supplementary motor areas

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