Does the surgical route matter in cerebellar mutism syndrome? Comparing transvermian and telovelar approaches for pediatric posterior fossa tumors.
This review of 16 studies comprising 1,369 pediatric posterior fossa tumor patients found no statistically significant difference in cerebellar mutism syndrome risk between transvermian and telovelar surgical approaches (pooled OR 1.85, 95% CI 0.95–3.59; p=0.07).
Open original publication →What the AI sees
This review of 16 studies comprising 1,369 pediatric posterior fossa tumor patients found no statistically significant difference in cerebellar mutism syndrome risk between transvermian and telovelar surgical approaches (pooled OR 1.85, 95% CI 0.95–3.59; p=0.07).
Research significance
The evidence does not demonstrate that choosing the telovelar rather than transvermian route prevents CMS; as an inference requiring stronger prospective evidence, surgical-route selection might still influence risk because the pooled estimate and wide confidence interval do not exclude a clinically meaningful difference.
Source abstract
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.