Postoperative speech impairment and cranial nerve deficits in children undergoing posterior fossa tumor surgery with intraoperative MRI - a prospective multinational study.

BACKGROUND: Postoperative speech impairment (POSI) and cranial nerve deficits (CND) are common complications of pediatric posterior fossa (PF) tumor surgery. Intraoperative MRI (ioMRI) has proven a useful tool in achieving gross total resection. The risk of POSI and CND with ioMRI remains unclear, m...

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Autores: Laustsen AF, Grønbæk JK, Fric R, Avula S, Mallucci C, Nilsson P, Nyman P, Hauser P, Mudra K, Kiudeliene R, Rocka S, Hjort MA, Brandsma R, Hoving E, Carai A, Beneš V, Táborská J, Dorfer C, Jacobs S, Pavon-Mengual M, Skjøth-Rasmussen J, Schmiegelow K, Sehested A, Mathiasen R, Juhler M
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2025
País:España
Institución:Fundació Sant Joan de Déu
Repositorio:r-FSJD. Repositorio Institucional de Producción Científica de la Fundació Sant Joan de Déu
OAI Identifier:oai:dnet:r-fsjd______::c34f0d442c745c91debfd201c0eacae1
Acceso en línea:https://fsjd.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=29124
Access Level:acceso abierto
Palabra clave:Cerebellar mutism syndrome
Cranial Nerve Deficits
Intraoperative Magnetic Resonance Imaging
Pediatric Neurosurgery
Posterior Fossa Tumor
Posterior Fossa syndrome
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spelling Postoperative speech impairment and cranial nerve deficits in children undergoing posterior fossa tumor surgery with intraoperative MRI - a prospective multinational study.Laustsen AFGrønbæk JKFric RAvula SMallucci CNilsson PNyman PHauser PMudra KKiudeliene RRocka SHjort MABrandsma RHoving ECarai ABeneš VTáborská JDorfer CJacobs SPavon-Mengual MSkjøth-Rasmussen JSchmiegelow KSehested AMathiasen RJuhler MCerebellar mutism syndromeCranial Nerve DeficitsIntraoperative Magnetic Resonance ImagingPediatric NeurosurgeryPosterior Fossa TumorPosterior Fossa syndromeBACKGROUND: Postoperative speech impairment (POSI) and cranial nerve deficits (CND) are common complications of pediatric posterior fossa (PF) tumor surgery. Intraoperative MRI (ioMRI) has proven a useful tool in achieving gross total resection. The risk of POSI and CND with ioMRI remains unclear, making it the primary scope of this study. Additionally, we assessed whether POSI was associated with CND. METHODS: We prospectively included pediatric patients undergoing PF tumor surgery in 36 centers across 15 European countries. Neurological status and speech were assessed preoperatively and 1-4 weeks postoperatively. Surgical details, including tumor location and use of ioMRI, were recorded within 72 h of surgery. Postoperative CND were categorized as 0, 1, 2, or = 3 nerves affected; POSI as habitual, reduced speech, or mutism. Proportional odds models estimated odds ratios (OR) for 1) POSI with stepwise adjustment for tumor location and age, and 2) CND with adjustment for preoperative CND and tumor location. Subgroup analyses assessed systematic differences, missing data, center-level effects, and histology adjustment. RESULTS: Of 790 primary PF tumor surgeries, 141 (18%) involved ioMRI. POSI occurred in 183/790 (23%) and postoperative CND in 213/790 (27%). POSI-risk with ioMRI showed non-significant unadjusted OR (95% CI) 0.83 (0.53;1.30); adjusted OR 0.76 (0.43;1.35). Fewer CNDs were observed with ioMRI (unadjusted OR 0.63 (0.40;1.00), adjusted OR 0.58 (0.33;0.94), p = 0.03). POSI-risk was associated with more CNDs (adjusted OR for 1 CND: 2.06 (1.15;3.68); 2 CND: 2.13 (1.02;4.42); = 3 CND: 4.15 (1.98;8.70), p < 0.05). CONCLUSIONS: ioMRI was not associated with increased risk of postoperative complications in this multicenter cohort. The reduction in CND among ioMRI cases may reflect derived effects on surgical decision-making, expertise, case-load and case-mix. Results should be interpreted with caution due to limited intraoperative data. The association between POSI-risk and cumulative CND may indicate extensive brainstem involvement. Our findings highlight the need to further explore how ioMRI-guided strategies affect functional outcomes in pediatric PF tumour surgery. CLINICAL TRIALS ID: NCT02300766 (October 2014).SPRINGER WIEN2025info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttps://fsjd.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=29124ACTA NEUROCHIRURGICAISSN: 00016268ISSNe: 09420940reponame:r-FSJD. Repositorio Institucional de Producción Científica de la Fundació Sant Joan de Déuinstname:Fundació Sant Joan de DéuInglésinfo:eu-repo/semantics/openAccessoai:dnet:r-fsjd______::c34f0d442c745c91debfd201c0eacae12026-05-27T12:37:41Z
dc.title.none.fl_str_mv Postoperative speech impairment and cranial nerve deficits in children undergoing posterior fossa tumor surgery with intraoperative MRI - a prospective multinational study.
title Postoperative speech impairment and cranial nerve deficits in children undergoing posterior fossa tumor surgery with intraoperative MRI - a prospective multinational study.
spellingShingle Postoperative speech impairment and cranial nerve deficits in children undergoing posterior fossa tumor surgery with intraoperative MRI - a prospective multinational study.
Laustsen AF
Cerebellar mutism syndrome
Cranial Nerve Deficits
Intraoperative Magnetic Resonance Imaging
Pediatric Neurosurgery
Posterior Fossa Tumor
Posterior Fossa syndrome
title_short Postoperative speech impairment and cranial nerve deficits in children undergoing posterior fossa tumor surgery with intraoperative MRI - a prospective multinational study.
title_full Postoperative speech impairment and cranial nerve deficits in children undergoing posterior fossa tumor surgery with intraoperative MRI - a prospective multinational study.
title_fullStr Postoperative speech impairment and cranial nerve deficits in children undergoing posterior fossa tumor surgery with intraoperative MRI - a prospective multinational study.
title_full_unstemmed Postoperative speech impairment and cranial nerve deficits in children undergoing posterior fossa tumor surgery with intraoperative MRI - a prospective multinational study.
title_sort Postoperative speech impairment and cranial nerve deficits in children undergoing posterior fossa tumor surgery with intraoperative MRI - a prospective multinational study.
dc.creator.none.fl_str_mv Laustsen AF
Grønbæk JK
Fric R
Avula S
Mallucci C
Nilsson P
Nyman P
Hauser P
Mudra K
Kiudeliene R
Rocka S
Hjort MA
Brandsma R
Hoving E
Carai A
Beneš V
Táborská J
Dorfer C
Jacobs S
Pavon-Mengual M
Skjøth-Rasmussen J
Schmiegelow K
Sehested A
Mathiasen R
Juhler M
author Laustsen AF
author_facet Laustsen AF
Grønbæk JK
Fric R
Avula S
Mallucci C
Nilsson P
Nyman P
Hauser P
Mudra K
Kiudeliene R
Rocka S
Hjort MA
Brandsma R
Hoving E
Carai A
Beneš V
Táborská J
Dorfer C
Jacobs S
Pavon-Mengual M
Skjøth-Rasmussen J
Schmiegelow K
Sehested A
Mathiasen R
Juhler M
author_role author
author2 Grønbæk JK
Fric R
Avula S
Mallucci C
Nilsson P
Nyman P
Hauser P
Mudra K
Kiudeliene R
Rocka S
Hjort MA
Brandsma R
Hoving E
Carai A
Beneš V
Táborská J
Dorfer C
Jacobs S
Pavon-Mengual M
Skjøth-Rasmussen J
Schmiegelow K
Sehested A
Mathiasen R
Juhler M
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Cerebellar mutism syndrome
Cranial Nerve Deficits
Intraoperative Magnetic Resonance Imaging
Pediatric Neurosurgery
Posterior Fossa Tumor
Posterior Fossa syndrome
topic Cerebellar mutism syndrome
Cranial Nerve Deficits
Intraoperative Magnetic Resonance Imaging
Pediatric Neurosurgery
Posterior Fossa Tumor
Posterior Fossa syndrome
description BACKGROUND: Postoperative speech impairment (POSI) and cranial nerve deficits (CND) are common complications of pediatric posterior fossa (PF) tumor surgery. Intraoperative MRI (ioMRI) has proven a useful tool in achieving gross total resection. The risk of POSI and CND with ioMRI remains unclear, making it the primary scope of this study. Additionally, we assessed whether POSI was associated with CND. METHODS: We prospectively included pediatric patients undergoing PF tumor surgery in 36 centers across 15 European countries. Neurological status and speech were assessed preoperatively and 1-4 weeks postoperatively. Surgical details, including tumor location and use of ioMRI, were recorded within 72 h of surgery. Postoperative CND were categorized as 0, 1, 2, or = 3 nerves affected; POSI as habitual, reduced speech, or mutism. Proportional odds models estimated odds ratios (OR) for 1) POSI with stepwise adjustment for tumor location and age, and 2) CND with adjustment for preoperative CND and tumor location. Subgroup analyses assessed systematic differences, missing data, center-level effects, and histology adjustment. RESULTS: Of 790 primary PF tumor surgeries, 141 (18%) involved ioMRI. POSI occurred in 183/790 (23%) and postoperative CND in 213/790 (27%). POSI-risk with ioMRI showed non-significant unadjusted OR (95% CI) 0.83 (0.53;1.30); adjusted OR 0.76 (0.43;1.35). Fewer CNDs were observed with ioMRI (unadjusted OR 0.63 (0.40;1.00), adjusted OR 0.58 (0.33;0.94), p = 0.03). POSI-risk was associated with more CNDs (adjusted OR for 1 CND: 2.06 (1.15;3.68); 2 CND: 2.13 (1.02;4.42); = 3 CND: 4.15 (1.98;8.70), p < 0.05). CONCLUSIONS: ioMRI was not associated with increased risk of postoperative complications in this multicenter cohort. The reduction in CND among ioMRI cases may reflect derived effects on surgical decision-making, expertise, case-load and case-mix. Results should be interpreted with caution due to limited intraoperative data. The association between POSI-risk and cumulative CND may indicate extensive brainstem involvement. Our findings highlight the need to further explore how ioMRI-guided strategies affect functional outcomes in pediatric PF tumour surgery. CLINICAL TRIALS ID: NCT02300766 (October 2014).
publishDate 2025
dc.date.none.fl_str_mv 2025
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://fsjd.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=29124
url https://fsjd.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=29124
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv SPRINGER WIEN
publisher.none.fl_str_mv SPRINGER WIEN
dc.source.none.fl_str_mv ACTA NEUROCHIRURGICA
ISSN: 00016268
ISSNe: 09420940
reponame:r-FSJD. Repositorio Institucional de Producción Científica de la Fundació Sant Joan de Déu
instname:Fundació Sant Joan de Déu
instname_str Fundació Sant Joan de Déu
reponame_str r-FSJD. Repositorio Institucional de Producción Científica de la Fundació Sant Joan de Déu
collection r-FSJD. Repositorio Institucional de Producción Científica de la Fundació Sant Joan de Déu
repository.name.fl_str_mv
repository.mail.fl_str_mv
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