{"id":"48a4c765-eb7d-41d9-910c-c5f9cf08e8b7","slug":"posterior-fossa-syndrome-in-children-following-tumor-resection-knowledge-update","title":"Posterior fossa syndrome in children following tumor resection: Knowledge update","authors":["Nisha Gadgil","Daniel Hansen","James Barry","Rocky Chang","Sandi Lam"],"abstract":"A 2-year-old female presented with a 2-month history of recalcitrant vomiting followed by ataxia and lethargy. Computed tomography (CT) scan of the head showed a large solid and cystic mass in the cerebellar vermis with severe hydrocephalus. Magnetic resonance imaging (MRI) demonstrated a 6.0 cm × 4.4 cm × 4.2 cm uniformly enhancing mass concerning for medulloblastoma with no evidence of spinal metastasis. She underwent external ventricular drain (EVD) placement and uneventful posterior fossa craniotomy with gross total resection of the lesion [ Figure 1 ]. For surgical exposure, the lower two-thirds of the vermis was split in the midline. Pathology confirmed classic medulloblastoma M0. Postoperatively, the patient displayed mutism, left-sided dysmetria, truncal/gait ataxia, and mild generalized hypotonia. The patient had postoperative hydrocephalus and required ventriculoperitoneal (VP) shunt placement. Her mutism symptoms improved significantly by 1 month, with continuing speech therapy and occupational therapy. At her 2-month follow-up, she demonstrated persistent mild dysarthria, ataxia, and left-sided dysmetria. The patient completed high-dose chemotherapy and radiation therapy. At last follow-up, 45 months after tumor resection, she had entered age-appropriate first grade academics, but continues to have mild dysarthria, dysmetria, hypotonia, and wide-based gait. (a) Axial and sagittal T1 postcontrast magnetic resonance images. Large heterogeneous tumor, dorsal to the brainstem and occupying much of the posterior fossa with resulting obstructive hydrocephalus. (b) Postresection images in similar planes showing gross total resection of tumor and resulting decompression of brain stem and ventricular system A 2-year-old boy presented with a 3-week history of progressive headache and daily vomiting. A CT scan revealed a solid mass in the fourth ventricle with moderate obstructive hydrocephalus. Presurgical MRI confirmed a 6.1 cm × 4.9 cm × 4.3 cm mass centered in the fourth ventricle and extending out the foramen of Luschka, consistent with an ependymoma. EVD placement and resection of the tumor were carried out in the same setting [ Figure 2 ]. Posterior fossa craniotomy was performed and gross total resection was achieved; however, the tumor presented itself posteriorly and no splitting of the vermis was required. Cranial nerve monitoring was utilized due to the intimate nature of the tumor to the brainstem. Pathology was consistent with ependymoma. Postoperatively, the patient had complete mutism, but he otherwise demonstrated good neurologic function. Due to continued hydrocephalus, a VP shunt was placed several days after the original operation. By 2 months, the patient was speaking a few words and by 6 months had returned to his age-appropriate neurologic baseline. He did receive proton beam radiation therapy to the tumor bed. (a) Fluid-attenuated inversion recovery axial and T2 coronal magnetic resonance images. Large nonenhancing tumor, wrapping ventral to the brainstem and occupying the posterior fossa with resultant hydrocephalus. (b) Same sequence postresection images showing gross total resection of tumor, with mild reduction in ventricular caliber","thumbnailUrl":"https://sni-digital-videos.s3.amazonaws.com/articles/48a4c765-eb7d-41d9-910c-c5f9cf08e8b7/featured/hero-1782420815781.png","publishDate":"2016-03-11T00:00:00.000Z","doi":"10.4103/2152-7806.178572","categories":["Pediatric Neurosurgery","Original Article"],"fullTextUrl":"http://surgicalneurologyint.com/wp-content/uploads/2016/03/6633/SNI-7-179.pdf"}