Cerebellar mutism in children: Report of six cases and potential mechanisms

Cerebellar mutism is a rare finding associated with resection of posterior fossa tumors or cerebellar hemorrhages, We reviewed the medical records of six children, aged 6 to 12 years, who developed cerebellar mutism after resection of a posterior fossa mass or as a result of posterior fossa trauma, From 1989 to 1994, 210 children underwent posterior fossa resection at our institution, and four developed mutism (an incidence of 1.6%), All four patients had primitive neuroectodermal tumors, The fifth patient experienced trauma, and another patient had an arteriovenous malformation (AVM). In four children, hydrocephalus developed as a result of their tumor or AVM, Four developed cerebellar mutism 24 to 48 hours after surgery or trauma, and one developed cerebellar mutism 5 days after surgery, coincident with hydrocephalus. In one, mutism occurred after a second resection was performed for a recurrence of his posterior fossa tumor, Cerebellar mutism lasted 10 days in one patient and 2 to 8 weeks in the other four, Dysarthria was apparent in four patients during the recovery phase, We suggest trauma to the dentate nucleus and/or its outflow tract, the superior cerebellar peduncle, as a cause of reversible mutism, Because posterior fossa tumors are common in children, mutism should be recognized as an important side effect of surgery. (C) 1997 by Elsevier Science Inc.