Longitudinal signal changes in the dentato-rubro-olivary pathway of patients with posterior fossa syndrome.
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BACKGROUND: Posterior fossa syndrome (PFS) is a complication of posterior fossa surgery that is associated with damage to the dentato-rubro-olivary pathway. The mechanism of injury to this pathway and its evolution is not well understood. METHODS: We conducted a retrospective review of brain magnetic resonance images (MRIs) in patients with medulloblastoma treated at a pediatric oncology center over an 8-year period. The MRI signal abnormalities in the superior cerebellar peduncles (SCPs), the dentate nuclei, and the inferior olivary nuclei (ION) were graded by a neuroradiologist blinded to the diagnosis of PFS immediately postoperative and at 6 and 12 months after surgery. A multivariable logistic regression model was used to estimate signal abnormalities in the SCPs and dentate nuclei at the immediately postoperative time point. A logistic generalized estimating equation model was used for longitudinal analysis of signal abnormalities in the SCPs, dentate nuclei, and ION. RESULTS: On immediately postoperative imaging, patients with PFS were more likely to exhibit T2 hyperintensity in the SCPs, as compared to patients without PFS (odds ratio [OR] = 8.71, 95% confidence interval [CI] = 3.93-19.27), which was more frequently due to surgical injury than transient edema (82% vs 18%). On longitudinal analysis, T1 hyperintensity in bilateral dentate nuclei was more likely to develop in the PFS group (OR = 2.16, 95% CI = 1.54-3.02). CONCLUSIONS: Patients with PFS had a higher incidence of SCP injury on immediately postoperative MRIs and were more likely to experience dystrophic mineralization in bilateral dentate nuclei during follow-up, suggestive of trans-synaptic degeneration.