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首页> 外文期刊>Child's nervous system: ChNS : official journal of the International Society for Pediatric Neurosurgery >Pediatric post-operative cerebellar mutism syndrome, cerebellar cognitive affective syndrome, and posterior fossa syndrome: historical review and proposed resolution to guide future study
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Pediatric post-operative cerebellar mutism syndrome, cerebellar cognitive affective syndrome, and posterior fossa syndrome: historical review and proposed resolution to guide future study

机译：小儿术后小脑突变综合征，小脑认知情感综合征，和后窝综合征：历史评论和建议决议引导未来的研究

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Background Cerebellar mutism (CM), pseudobulbar palsy, posterior fossa syndrome (PFS), and cerebellar cognitive affective syndrome (CCAS) are terms that have been used, sometimes interchangeably, to refer to the complex neurological constellation that occurs following surgical removal of cerebellar and fourth ventricular tumors, mostly in children, but also sometimes in adults. Methods This paper reviews the origins of what is now regarded as pediatric post-operative cerebellar mutism, the cerebellar cognitive affective syndrome, and the neurological manifestations of injury to or disruption of brainstem and cerebellar structures. It examines the specific components of each of these phenomena in the context of the evolving understanding of the role of the cerebellum in nervous system function. Results Children undergoing surgical management of tumors in the posterior cranial fossa are at risk of experiencing cranial neuropathies, corticospinal damage, cerebellar ataxia and related motor disorders, neuropsychiatric and cognitive changes, and in some patients, mutism. These clinical presentations are differentiated from each other and examined in the context of the relevant anatomical structures and distributed neural circuits. The term posterior fossa syndrome is not sufficiently helpful in distinguishing the different elements of the clinical phenomena from each other, and because of this lack of precision and specificity, there is consensus among investigators in the international Posterior Fossa Society that the designation be retired. Conclusions Using contemporary brain imaging methods and guided by careful clinical observation and meticulous definition of clinical phenomenology, it is now feasible to perform detailed structure function correlation analyses to achieve two critical goals in the care of children with tumors in the posterior cranial fossa. The first goal is to identify and understand the neural circuits responsible for the different manifestations-arousal, cranial neuropathies, long tract signs, cerebellar motor syndrome, cerebellar vestibular syndrome, cerebellar cognitive affective syndrome including emotional dyscontrol, and mutism. The second goal is to transform this knowledge into practical clinical intervention, preventing the complications inherent in the necessary surgery whenever possible, and develop new approaches to treatment with methods including brain modulation targeting interconnected nodes of the damaged neural circuits.
机译：背景技术小脑突变（CM），假骨杆麻痹，后骨综合征（PFS）和小脑认知情感综合征（CCAS）有时是可互换的，以指手术去除小脑和骨骼的复杂神经系统星座中的术语。第四间心室肿瘤，主要是儿童，但也有时候在成年人中。方法本文综述了目前被认为是小儿疗法小脑突变，小脑认知情感综合征以及脑干和小脑结构破坏的神经系统表现形式的起源。它在不断了解细胞在神经系统功能中的作用的情况下，检查这些现象的特定组分。结果后颅窝肿瘤手术管理的儿童面临着体验颅神经病，皮质脊髓损伤，小脑共济失障，神经精神和认知变化，以及一些患者的风险，以及一些患者。这些临床介绍彼此区分，并在相关解剖结构和分布式神经电路的背景下检查。术语后浮游综合征在彼此中区分临床现象的不同元素并没有足够的帮助，并且由于这种缺乏精度和特异性，在国际后罗萨社会中的调查人员之间存在共识，即指定被退休。结论使用当代脑成像方法和仔细的临床观察和临床现象学的细致定义，现在可以进行详细的结构功能相关分析，以在后颅窝中肿瘤的照顾中实现两个关键目标的可行性。第一个目标是识别和理解负责不同表现形式，颅神经病，长的颅骨症，大脑电机综合征，小脑前庭综合征，小脑认知情感综合征，包括情感障碍和互感。第二个目标是将这些知识转化为实际临床干预，防止在可能的手术中固有的固有固有的并发症，并开发新方法，以瞄准损坏的神经电路的互连节点的脑调制的方法。

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