Open AccessA CBF decrease in the left supplementary motor areas: New insight into postoperative pediatric cerebellar mutism syndrome using arterial spin labeling perfusion MRI
Author(s) -
Jennifer Boisgontier,
Ludovic Fillon,
Caroline Rutten,
Ana Saitovitch,
Christelle Dufour,
Hervé Lemaître,
Kévin Beccaria,
Thomas Blauwblomme,
Raphaël Lévy,
Volodia Dangouloff-Ros,
D. Grévent,
CharlesJoris Roux,
Jacques Grill,
Alice Vinçon-Leite,
Lila Saidoun,
Franck Bourdeaut,
Mônica Zilbovicius,
Nathalie Boddaert,
Stéphanie Puget
Publication year - 2021
Publication title -
journal of cerebral blood flow and metabolism
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.167
H-Index - 193
eISSN - 1559-7016
pISSN - 0271-678X
DOI - 10.1177/0271678x211031321
Subject(s) - supplementary motor area , sma* , cerebral blood flow , medicine , perfusion , arterial spin labeling , hyperintensity , anesthesia , cardiology , magnetic resonance imaging , radiology , functional magnetic resonance imaging , mathematics , combinatorics
Postoperative pediatric cerebellar mutism syndrome (pCMS), characterized mainly by delayed onset transient mutism is a poorly understood complication that may occur after pediatric medulloblastoma (MB) resection. Our aim was to investigate postoperative changes in whole-brain cerebral blood flow (CBF) at rest in pCMS patients using arterial spin labeling (ASL) perfusion imaging. This study compared preoperative and postoperative T2-weighted signal abnormalities and CBF using a voxel-wise, whole-brain analysis in 27 children undergoing MB resection, including 11 patients who developed mutism and 16 who did not. Comparison of postoperative T2 signal abnormalities between patients who developed pCMS (mean age 7.0 years) and those who did not showed that pCMS (mean age 8.9 years) patients were significantly more likely to present with T2-weighted hyperintensities in the right dentate nucleus (DN) (p = 0.02). Comparison of preoperative and postoperative CBF in patients with pCMS showed a significant postoperative CBF decrease in the left pre-supplementary motor area (pre-SMA) (p = 0.007) and SMA (p = 0.009). In patients who did not develop pCMS, no significant differences were observed. Findings provide evidence of an association between pCMS, injury to the right DN, and left pre-SMA/SMA hypoperfusion, areas responsible for speech. This supports the relevance of CBF investigations in pCMS.