Does the surgical route matter in cerebellar mutism syndrome? Comparing transvermian and telovelar approaches for pediatric posterior fossa tumors.

INTRODUCTION

Children and adolescents undergoing surgery for posterior fossa brain tumors are at risk of developing cerebellar mutism syndrome (CMS). Mutism or reduced speech is a cardinal symptom; however, CMS is also characterized by motor, cognitive, and emotional difficulties that may persist as long-term sequelae. The potential association between vermian incision during tumor resection and an increased incidence of CMS remains a subject of debate in the literature.

RESEARCH QUESTION: This review aimed to evaluate whether the telovelar approach is associated with a lower risk of CMS compared with the transvermian approach.

MATERIAL AND

METHODS

Original studies were identified through a structured literature search of the PubMed and EMBASE databases. Postoperative speech outcomes and surgical approaches were extracted, and a pooled odds ratio (OR) was estimated using a random-effects model.

RESULTS

16 studies (PS = 6, RS = 9, mixed PS/RS = 1) met the inclusion criteria, comprising a total of 1369 patients. A pooled estimate yielded an OR of 1.85 (95% CI: 0.95-3.59, p = 0.07). Subanalysis of prospective studies yielded a pooled OR of 1.10 (95% CI: 0.29-4.19) and did not alter the overall result.

CONCLUSION

This review adds to the existing evidence on surgery-related risk factors for CMS. We found no significant difference in CMS risk between transvermian and telovelar approaches, indicating no clear advantage of either approach in preventing CMS.