Preoperative hydrocephalus and the risk of postoperative speech impairment following posterior fossa tumour surgery in children: results from a prospective, multinational cohort study
Por:
Foldbjerg A, Fric R, Grønbæk JK, Beneš V, Santa-María López V, Nestler U, Carai A, Solanki G, Avula S, Malluci C, Nilsson P, Nyman P, Hjort MA, Brandsma R, Hoving E, Bua A, Táborská J, Mudra K, Balázs M, Rutkaiskiene G, Rocka S, Lemiere J, Wilhelmy F, Dorfer C, Sehested A, Juhler M and Mathiasen R
Publicada:
4 feb 2026
Ahead of Print:
4 feb 2026
Resumen:
BackgroundCerebellar mutism syndrome (CMS) is a common complication of paediatric posterior fossa (PF) tumour surgery, with postoperative speech impairment (POSI) as the cardinal symptom. Preoperative hydrocephalus (pHC) is present in up to 70% of cases of paediatric PF tumours, but its association with POSI remains unclear. This study investigated whether pHC is an independent risk factor for POSI and assessed the impact of alleviating pHC prior to tumour resection on POSI risk.MethodsWe included 800 children who underwent PF tumour surgery between 2014 and 2024 at 35 centres across 13 countries in the European CMS study. Speech and neurological assessments were conducted pre- and postoperatively. Neurosurgeons assessed pHC status, pHC treatment and tumour location; histology was recorded at a 2-month follow-up. pHC treatment was categorised as "yes" (pHC alleviated prior to tumour surgery) and "no" (pHC alleviated by tumour surgery alone). POSI was categorised as "habitual speech", "reduced speech" or "mutism".ResultsOf 800 patients, 515 (64%) had pHC. Absence of pHC was associated with lower POSI risk in univariate analysis (OR 0.51 (95% CI 0.35; 0.76)), but this reversed and became non-significant after adjustment (1.20 (0.60; 2.41)). pHC treatment was associated with an increased POSI risk in the univariate analysis (1.93 (1.14; 3.26)), which became non-significant in the adjusted analysis (1.15 (0.60; 2.21)).ConclusionThe presence of pHC was not independently associated with POSI nor did treatment of pHC prior to tumour resection appear to reduce the risk of POSI. These findings highlight the importance of individualizing pHC management in paediatric PF tumour cases, with decisions guided by the clinical context.Trial registrationClinical Trials ID NCT02300766 (October 2014).
Filiaciones:
Foldbjerg A:
Department of Neurosurgery, Rigshospitalet, Copenhagen, Denmark
Department of Pediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark
Fric R:
Department of Neurosurgery, University Hospital Oslo-Rikshospitalet, Oslo, Norway
Grønbæk JK:
Department of Neurosurgery, Rigshospitalet, Copenhagen, Denmark
Department of Pediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark
Beneš V:
Department of Neurosurgery, 2nd Medical Faculty and Motol University Hospital, Prague, Czechia
Santa-María López V:
Neuro-Oncology Unit, Pediatric Cancer Center Barcelona, Hospital Sant Joan de Déu, Barcelona, Spain
Nestler U:
Department of Neurosurgery, Fondation Lenval Children's Hospital, Nice, France
Carai A:
Department of Neurosurgery, Bambino Gesù Children's Hospital, Rome, Italy
Solanki G:
Department of Paediatric Neurosurgery, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
Avula S:
Department of Radiology, Alder Hey Children's NHS Foundation, Liverpool, UK
Malluci C:
Department of Neurosurgery, Alder Hey Children's NHS Trust, Liverpool, UK
Nilsson P:
Department of Medical Sciences/Neurosurgery, Uppsala University, Uppsala University Hospital, Uppsala, Sweden
Nyman P:
Crown Princess Victoria Children's Hospital, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
Hjort MA:
Department of Pediatric Hematology and Oncology, St. Olavs Hospital, Trondheim, Norway
Brandsma R:
Princess Maxima Center for Pediatric Oncology, Utrecht, Netherlands
Hoving E:
Princess Maxima Center for Pediatric Oncology, Utrecht, Netherlands
Bua A:
Department of Neurosurgery, Bambino Gesù Children's Hospital, Rome, Italy
Táborská J:
Department of Neurosurgery, 2nd Medical Faculty and Motol University Hospital, Prague, Czechia
Mudra K:
2nd, Department of Pediatrics, Semmelweis University, Budapest, Hungary
Balázs M:
2nd, Department of Pediatrics, Semmelweis University, Budapest, Hungary
Rutkaiskiene G:
Department of Pediatrics, Lithuanian University of Health Science, Kaunas, Lithuania
Rocka S:
Clinic of Neurology and Neurosurgery, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
Lemiere J:
Pediatric Oncology, Department of Oncology, KU Leuven, Louvain, Belgium
Wilhelmy F:
Department of Neurosurgery, University Hospital Leipzig, Leipzig, Germany
Dorfer C:
Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
Sehested A:
Department of Pediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark
Juhler M:
Department of Neurosurgery, Rigshospitalet, Copenhagen, Denmark
Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark
Mathiasen R:
Department of Pediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark
Green Submitted, hybrid
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