Journal article
Pediatric postoperative cerebellar cognitive affective syndrome follows outflow pathway lesions
Neurology, Vol.93(16), pp.e1561-e1571
10/15/2019
DOI: 10.1212/WNL.0000000000008326
PMCID: PMC6815203
PMID: 31527284
Abstract
To evaluate lesion location after pediatric cerebellar tumor resection in relation to the development of severe cognitive and affective disturbances, or cerebellar cognitive affective syndrome (CCAS).
The postsurgical lesion location of 195 pediatric patients with cerebellar tumors was mapped onto a template brain. Individuals with CCAS were matched to 2 participants without CCAS by sex, age, and lesion volume. Lesion analyses included both a hypothesis-driven evaluation of the cerebellar outflow pathway (deep nuclei and superior cerebellar peduncles) and data-driven multivariate lesion symptom mapping. Lesion-associated networks were evaluated by comparing connectivity patterns between the lesion location of cases with and those without CCAS with resting-state functional connectivity MRI data from large normative adult and pediatric cohorts.
CCAS was present in 48 of 195 participants (24.6%) and was strongly associated with cerebellar outflow tract lesions (
< 0.0001). Lesion symptom mapping also highlighted the cerebellar outflow pathway, with peak findings in the fastigial nuclei extending into the inferior vermis. Lesion network mapping revealed that the cerebellar region most associated with CCAS was functionally connected to the thalamic mediodorsal nucleus, among other sites, and that higher connectivity between lesion location and the mediodorsal nucleus predicts CCAS occurrence (
< 0.01). A secondary analysis of 27 participants with mutism revealed similar localization of lesions and lesion-associated networks.
Lesions of the cerebellar outflow pathway and inferior vermis are associated with major cognitive and affective disturbances after pediatric cerebellar tumor resection, and disrupted communication between the cerebellum and the thalamic mediodorsal nucleus may be important.
Details
- Title: Subtitle
- Pediatric postoperative cerebellar cognitive affective syndrome follows outflow pathway lesions
- Creators
- Fatimah M Albazron - From the Neuroimaging and Noninvasive Brain Stimulation Laboratory (F.M.A., J.B., A.D.B.), Departments of Pediatrics, Neurology, and Psychiatry, University of Iowa Hospitals and Clinics, Iowa City; Department of Pediatric Neurology (R.M.J.), Department of Radiation Oncology (T.I.Y.), Department of Psychiatry (M.B.P.), and Department of Child and Adolescent Psychiatry and Pediatric Hematology Oncology (A.N.A.), Massachusetts General Hospital; Department of Neurology (A.L.C.), Boston Children's Hospital, MA; Department of Psychiatry (P.C.N.), University of Iowa Hospitals and Clinics, Iowa City; and Department of Pediatric Hematology Oncology (M.S.), Stead Family Children's Hospital, Iowa City, IAJoel Bruss - From the Neuroimaging and Noninvasive Brain Stimulation Laboratory (F.M.A., J.B., A.D.B.), Departments of Pediatrics, Neurology, and Psychiatry, University of Iowa Hospitals and Clinics, Iowa City; Department of Pediatric Neurology (R.M.J.), Department of Radiation Oncology (T.I.Y.), Department of Psychiatry (M.B.P.), and Department of Child and Adolescent Psychiatry and Pediatric Hematology Oncology (A.N.A.), Massachusetts General Hospital; Department of Neurology (A.L.C.), Boston Children's Hospital, MA; Department of Psychiatry (P.C.N.), University of Iowa Hospitals and Clinics, Iowa City; and Department of Pediatric Hematology Oncology (M.S.), Stead Family Children's Hospital, Iowa City, IARobin M Jones - From the Neuroimaging and Noninvasive Brain Stimulation Laboratory (F.M.A., J.B., A.D.B.), Departments of Pediatrics, Neurology, and Psychiatry, University of Iowa Hospitals and Clinics, Iowa City; Department of Pediatric Neurology (R.M.J.), Department of Radiation Oncology (T.I.Y.), Department of Psychiatry (M.B.P.), and Department of Child and Adolescent Psychiatry and Pediatric Hematology Oncology (A.N.A.), Massachusetts General Hospital; Department of Neurology (A.L.C.), Boston Children's Hospital, MA; Department of Psychiatry (P.C.N.), University of Iowa Hospitals and Clinics, Iowa City; and Department of Pediatric Hematology Oncology (M.S.), Stead Family Children's Hospital, Iowa City, IATorunn I Yock - From the Neuroimaging and Noninvasive Brain Stimulation Laboratory (F.M.A., J.B., A.D.B.), Departments of Pediatrics, Neurology, and Psychiatry, University of Iowa Hospitals and Clinics, Iowa City; Department of Pediatric Neurology (R.M.J.), Department of Radiation Oncology (T.I.Y.), Department of Psychiatry (M.B.P.), and Department of Child and Adolescent Psychiatry and Pediatric Hematology Oncology (A.N.A.), Massachusetts General Hospital; Department of Neurology (A.L.C.), Boston Children's Hospital, MA; Department of Psychiatry (P.C.N.), University of Iowa Hospitals and Clinics, Iowa City; and Department of Pediatric Hematology Oncology (M.S.), Stead Family Children's Hospital, Iowa City, IAMargaret B Pulsifer - From the Neuroimaging and Noninvasive Brain Stimulation Laboratory (F.M.A., J.B., A.D.B.), Departments of Pediatrics, Neurology, and Psychiatry, University of Iowa Hospitals and Clinics, Iowa City; Department of Pediatric Neurology (R.M.J.), Department of Radiation Oncology (T.I.Y.), Department of Psychiatry (M.B.P.), and Department of Child and Adolescent Psychiatry and Pediatric Hematology Oncology (A.N.A.), Massachusetts General Hospital; Department of Neurology (A.L.C.), Boston Children's Hospital, MA; Department of Psychiatry (P.C.N.), University of Iowa Hospitals and Clinics, Iowa City; and Department of Pediatric Hematology Oncology (M.S.), Stead Family Children's Hospital, Iowa City, IAAlexander L Cohen - From the Neuroimaging and Noninvasive Brain Stimulation Laboratory (F.M.A., J.B., A.D.B.), Departments of Pediatrics, Neurology, and Psychiatry, University of Iowa Hospitals and Clinics, Iowa City; Department of Pediatric Neurology (R.M.J.), Department of Radiation Oncology (T.I.Y.), Department of Psychiatry (M.B.P.), and Department of Child and Adolescent Psychiatry and Pediatric Hematology Oncology (A.N.A.), Massachusetts General Hospital; Department of Neurology (A.L.C.), Boston Children's Hospital, MA; Department of Psychiatry (P.C.N.), University of Iowa Hospitals and Clinics, Iowa City; and Department of Pediatric Hematology Oncology (M.S.), Stead Family Children's Hospital, Iowa City, IAPeg C Nopoulos - From the Neuroimaging and Noninvasive Brain Stimulation Laboratory (F.M.A., J.B., A.D.B.), Departments of Pediatrics, Neurology, and Psychiatry, University of Iowa Hospitals and Clinics, Iowa City; Department of Pediatric Neurology (R.M.J.), Department of Radiation Oncology (T.I.Y.), Department of Psychiatry (M.B.P.), and Department of Child and Adolescent Psychiatry and Pediatric Hematology Oncology (A.N.A.), Massachusetts General Hospital; Department of Neurology (A.L.C.), Boston Children's Hospital, MA; Department of Psychiatry (P.C.N.), University of Iowa Hospitals and Clinics, Iowa City; and Department of Pediatric Hematology Oncology (M.S.), Stead Family Children's Hospital, Iowa City, IAAnnah N Abrams - From the Neuroimaging and Noninvasive Brain Stimulation Laboratory (F.M.A., J.B., A.D.B.), Departments of Pediatrics, Neurology, and Psychiatry, University of Iowa Hospitals and Clinics, Iowa City; Department of Pediatric Neurology (R.M.J.), Department of Radiation Oncology (T.I.Y.), Department of Psychiatry (M.B.P.), and Department of Child and Adolescent Psychiatry and Pediatric Hematology Oncology (A.N.A.), Massachusetts General Hospital; Department of Neurology (A.L.C.), Boston Children's Hospital, MA; Department of Psychiatry (P.C.N.), University of Iowa Hospitals and Clinics, Iowa City; and Department of Pediatric Hematology Oncology (M.S.), Stead Family Children's Hospital, Iowa City, IAMariko Sato - From the Neuroimaging and Noninvasive Brain Stimulation Laboratory (F.M.A., J.B., A.D.B.), Departments of Pediatrics, Neurology, and Psychiatry, University of Iowa Hospitals and Clinics, Iowa City; Department of Pediatric Neurology (R.M.J.), Department of Radiation Oncology (T.I.Y.), Department of Psychiatry (M.B.P.), and Department of Child and Adolescent Psychiatry and Pediatric Hematology Oncology (A.N.A.), Massachusetts General Hospital; Department of Neurology (A.L.C.), Boston Children's Hospital, MA; Department of Psychiatry (P.C.N.), University of Iowa Hospitals and Clinics, Iowa City; and Department of Pediatric Hematology Oncology (M.S.), Stead Family Children's Hospital, Iowa City, IAAaron D Boes - From the Neuroimaging and Noninvasive Brain Stimulation Laboratory (F.M.A., J.B., A.D.B.), Departments of Pediatrics, Neurology, and Psychiatry, University of Iowa Hospitals and Clinics, Iowa City; Department of Pediatric Neurology (R.M.J.), Department of Radiation Oncology (T.I.Y.), Department of Psychiatry (M.B.P.), and Department of Child and Adolescent Psychiatry and Pediatric Hematology Oncology (A.N.A.), Massachusetts General Hospital; Department of Neurology (A.L.C.), Boston Children's Hospital, MA; Department of Psychiatry (P.C.N.), University of Iowa Hospitals and Clinics, Iowa City; and Department of Pediatric Hematology Oncology (M.S.), Stead Family Children's Hospital, Iowa City, IA. aaron-boes@uiowa.edu
- Resource Type
- Journal article
- Publication Details
- Neurology, Vol.93(16), pp.e1561-e1571
- Publisher
- United States
- DOI
- 10.1212/WNL.0000000000008326
- PMID
- 31527284
- PMCID
- PMC6815203
- ISSN
- 0028-3878
- eISSN
- 1526-632X
- Grant note
- T32 MH112510 / NIMH NIH HHS K12 NS098482 / NINDS NIH HHS K12 HD027748 / NICHD NIH HHS
- Language
- English
- Date published
- 10/15/2019
- Academic Unit
- Roy J. Carver Department of Biomedical Engineering; Neurology; Psychiatry; Stead Family Department of Pediatrics; Iowa Neuroscience Institute; Neurology (Pediatrics)
- Record Identifier
- 9984070579002771
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