Mutism after surgery for posterior fossa tumors in children

The authors report 5 children operated upon for large midline cerebellar tumors, who developed mutism postoperatively and review other 160 cases documented in the literature. Mutism more often appears 24 to 72 hours after the operation; it is often associated to impairment of the oropharyngeal coordination and neurobehavioral symptoms, and may last from 7 days to several weeks. Its occurrence has been reported almost exclusively in children with large cerebellar midline tumors although rare cases with non tumoral lesions of in adult patients have been documented. Besides, this complication is not correlated with the size and histology of the tumor, the extent of the surgical removal or the entity of the hydrocephalus. Mutism after posterior fossa surgery seems to result from bilateral involvement of the paramedian cerebellar structures (deep nuclei, cerebellar peduncles), likely secondary to postoperative edema, which was noticed in 3 among 5 our own cases.