Association between perioperative factors and the occurrence of postoperative cerebellar mutism syndrome in children.
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PURPOSE: Postoperative cerebellar mutism syndrome (pCMS) is a complex condition involving neurological impairment including mutism, hypotonia and dysphagia, that occurs after resection of infratentorial lesions predominantly in children. While the literature has reported several preoperative risk factors, there is little knowledge on the surgeon's role and perioperative factors. Thus, we aimed to examine the association between perioperative features and pCMS. METHODS: This single-center study included 83 patients who underwent microsurgical resection of a cerebellar lesion in 2013-2022. Controls were matched to cases based on age using coarsened exact matching. There were 20 patients with pCMS. The parameters assessed included age, gender, the histology of the lesion, and the modified Rotterdam Risk Score. Intra- and perioperative factors such as the surgical approach; the extent of resection; the administration of dexamethasone, blood products, coagulative factors, and mannitol; the use of a preoperative cerebrospinal fluid (CSF) drain; and postoperative sodium and hemoglobin levels were examined. RESULTS: Crude-effect analysis showed associations between pCMS and medulloblastoma histology (odds ratio [OR] = 7.40, 95% confidence interval [CI] = [1.75, 31.17]) and the administration of blood products (OR = 4.82, 95% CI = [1.15, 20.16]). Moreover, there was a significant association between the occurrence of pCMS and hemoglobin (OR = 0.55, CI = [0.31, 0.96]) and sodium (OR = 1.21, 95% CI = [1.00, 1.46]) levels on postoperative day 1. Multivariate analysis confirmed the association with medulloblastoma histology (OR = 4.66, 95% CI = [1.13, 19.15]). CONCLUSION: In multivariate analysis, histology was the only significant factor for the development of pCMS. Nonetheless, there was a trend suggesting that the administration of blood products and the postoperative hemoglobin and sodium levels could represent risk factors for development of pCMS in this explorative analysis.