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Association of functional magnetic resonance imaging indices with postoperative language outcomes in patients with primary brain tumors.
Kundu B, Penwarden A, Wood JM, Gallagher TA, Andreoli MJ, Voss J, Meier T, Nair VA, Kuo JS, Field AS, Moritz C, Meyerand ME, Prabhakaran V.
both Broca and Wernicke areas. Preoperative deficits were related to increasing patient age and a shorter Wernicke area LAD. CONCLUSIONS: Overall, LAD and LI, as determined using fMRI in the context of these paradigms, may be useful indicators of postsurgical outcomes. Whereas tumor location may influence postoperative deficits, the results indicated that tumor proximity to an activation area might also interact with how the language network is affected as a whole by the lesion. Although the derivation of LI must be further validated in individual patients by using spatially specific statistical methods, the current results indicated that fMRI is a useful tool for predicting postoperative outcomes in patients with a single brain tumor. Neurosurg Focus. 2013 Apr;34(4):E7. doi: 10.3171/2013.2.FOCUS12410.
The role of secondary motor and language cortices in morbidity and mortality: a retrospective functional MRI study of surgical planning for patients with intracranial tumors.
Voss J, Meier TB, Freidel R, Kundu B, Nair VA, Holdsworth R, Kuo JS, Prabhakaran V.
tests of significance. The impact of other variables, including age, handedness, sex, and tumor grade, was also investigated. In a subset of patients, logistic regression was performed to identify the likelihood of deficits based on the LAD to primary and secondary regions. Finally, MantelCox log-rank tests were performed to determine whether survival time was significantly related to the LAD to secondary motor and language areas. RESULTS: A significant association was observed between the LAD to the SMA and the incidence of motor deficits, with the percentage of patients with deficits dropping for those in the LAD > 2 cm group. The relationship between the LAD to the pSMA and the incidence of language deficits was not significant. Logistic regression demonstrated that the LAD to primary sensorimotor cortex does affect the incidence of motor deficits, but that the LAD to SMA does not. Finally, the authors observed no relationship between the LAD to secondary regions and patient mortality rates. CONCLUSIONS: These results demonstrate that the LAD to SMA structures does affect morbidity, although not to the extent of LAD to primary structures. In addition, motor deficits are significantly associated with LAD to secondary structures, but language deficits are not. This should be considered by neurosurgeons for patient consultation and preoperative planning. PMID: 23544413 [PubMed - indexed for MEDLINE] PMCID: PMC3817821 Free PMC Article Pediatr Blood Cancer. 2008 Mar;50(3):706-8.
Speech-language and hearing complaints of children and adolescents with brain tumors.
Gonalves MI, Radzinsky TC, da Silva NS, Chiari BM, Consonni D.
speech-language and hearing complaints and disorders in children and adolescents with CNS tumor under treatment at one of the most important Brazilian reference center for pediatric cancer. One-hundred ninety patients were examined for speech-pathology screening and analysis: forty-two percent presented with complaints and symptoms. From the remaining patients, 68% presented clinical symptoms and 32% were actually free from any speechlanguage and hearing-related symptoms. The high incidence of complaints and symptoms indicate that these patients might benefit from specific rehabilitation interventions. (c) 2007 Wiley-Liss, Inc. NeuroRehabilitation. 2005;20(2):107-24.
Auditory-perceptual speech analysis in children with cerebellar tumours: a longterm follow-up study.
De Smet HJ, Catsman-Berrevoets C, Aarsen F, Verhoeven J, Marin P, Paquier PF.
Tumour type and size are high risk factors for the syndrome of "cerebellar" mutism and subsequent dysarthria.
Catsman-Berrevoets CE, Van Dongen HR, Mulder PG, Paz y Geuze D, Paquier PF, Lequin MH.
"Cerebellar mutis" and subsequent dysarthria (MSD) is a documented complication of posterior fossa surgery in children. In this prospective study the following risk factors for MSD were assessed: type, size and site of the tumour; hydrocephalus at presentation and after surgery, cerebellar incision site, postoperative infection, and cerebellar swelling. METHODS: In a consecutive series of 42 children with a cerebellar tumour, speech and neuroradiological studies (CT and MRI) were systematically analysed preoperatively and postoperatively. Speech was assessed using the Mayo Clinic lists and the severity of dysarthria using the Michigan rating scale. RESULTS: Twelve children (29%) developed MSD postoperatively. The type of tumour, midline localisation, and vermal incision were significant single independent risk factors. In addition, an interdependency of possible risk factors (tumour>5 cm, medulloblastoma) was found. CONCLUSION: MSD often occurs after paediatric cerebellar tumour removal and is most likely after removal of a medulloblastoma with a maximum lesion diameter>5 cm. PMID: 10567492 [PubMed - indexed for MEDLINE] PMCID: PMC1736675 Free PMC Article Acta Neurochir (Wien). 1994;131(1-2):74-9.
Transient mutism and speech disorders after posterior fossa surgery in children with brain tumours.
Kingma A, Mooij JJ, Metzemaekers JD, Leeuw JA.
Four patients aged 5 to 9 years with large tumours located in the posterior fossa (PNET, ependymoma or astrocytoma) are presented. Patients received standard neuropsychological assessments, including speech evaluation, prior to surgery. Following tumour resection, these 4 children developed transient mutism or different types of speech and cognitive disorders, associated with behavioural disturbances. We describe course and results of repeated postoperative neurological and neuropsychological evaluations. Full recovery of speech was seen in 3 out of 4 patients; the only child with persistent symptoms was the one who already had neuropsychological deficits before surgery. However, despite fast recovery of the speech disorders more persistent behavioural problems were found in 3 out of 4 patients. Possible pathogenesis anatomical location of this "cerebellar speech syndrome" are discussed, as well as the relevance of repeated neuropsychological assessments. Funct Neurol. 2013 Jan-Mar;28(1):55-61.
23731916 [PubMed - indexed for MEDLINE] PMCID: PMC3812717 Free PMC Article Brain Lang. 2011 May;117(2):69-76. doi: 10.1016/j.bandl.2011.01.002. Epub 2011 Feb 21.
Role of cerebellum in fine speech control in childhood: persistent dysarthria after surgical treatment for posterior fossa tumour.
Morgan AT, Ligeois F, Liederkerke C, Vogel AP, Hayward R, Harkness W, Chong K, VarghaKhadem F.
Cerebellar mutism.
Pitsika M, Tsitouras V.
literature. Pertinent publications were selected from the reference lists of the previously identified articles. Over the last few years an increasing number of prospective studies and reviews have provided valuable information regarding the cerebellar mutism syndrome. Importantly, the clarification of principal terminology that surrounds the wide clinical spectrum of the syndrome results in more focused research and more effective identification of this entity. In children who undergo surgery for medulloblastoma the incidence of cerebellar mutism syndrome was reported to be 24%, and significant risk factors so far are brainstem involvement and midline location of the tumor. The dentate-thalamo-cortical tracts and lesions that affect their integrity are considered significant pathophysiological issues, especially the tract that originates in the right cerebellar hemisphere. Moderate and severe forms of the cerebellar mutism syndrome are the most frequent types during the initial presentation, and the overall neurocognitive outcome is not as favorable as thought in the earlier publications. Advanced neuroimaging techniques could contribute to identification of high-risk patients preoperatively and allow for more effective surgical planning that should focus on maximal tumor resection with minimal risk to important neural structures. Properly designed multicenter trials are needed to provide stronger evidence regarding effective prevention of cerebellar mutism and the best therapeutic approaches for such patients with a combination of pharmacological agents and multidisciplinary speech and behavior augmentation. Cerebellum. 2011 Sep;10(3):551-62. doi: 10.1007/s12311-011-0273-2.
Heralding cerebellar mutism: evidence for pre-surgical language impairment as primary risk factor in posterior fossa surgery.
Di Rocco C, Chieffo D, Frassanito P, Caldarelli M, Massimi L, Tamburrini G.
PLI regressed after the operation in three out of the four subjects belonging to group II who did not develop CMS. PLI remained unchanged in the last child of this group. Posterior fossa tumour resection can have different effects on children with pre-existing language impairment (PLI). PLI can be considered a subclinical state of CMS in some children with posterior fossa tumour. However, in some children with PLI, the tumour resection may improve the linguistic abilities, as well as the other neurocognitive performances. In the present series, children with normal preoperative language function did not develop post-operative mutism. PMID: 21476131 [PubMed - indexed for MEDLINE] Neuro Oncol. 2012 Oct;14(10):1294-303. Epub 2012 Sep 5.
PMID: 22952198 [PubMed - indexed for MEDLINE] PMCID: PMC3452341 Free PMC Article Cortex. 2012 Feb;48(2):255-72. doi: 10.1016/j.cortex.2011.11.015. Epub 2011 Dec 7.
Aphasia induced by gliomas growing in the ventrolateral frontal region: assessment with diffusion MR tractography, functional MR imaging and neuropsychology.
Bizzi A, Nava S, Ferr F, Castelli G, Aquino D, Ciaraffa F, Broggi G, DiMeco F, Piacentini S.
Seven posterior patients showed aphasia classified as conduction (4), Broca (1), transcortical motor (1) and an isolated deficit of semantic fluency; one anterior patient had transcortical mixed aphasia. All posterior patients had invasion of the VPCG, however only patients with aphasia had also lesion extension to the AF as demonstrated by tractography dissections. All patients with language deficits had high grade glioma. Groups did not differ regarding tumour volume. A functional pars opercularis was identified with functional MR imaging (fMRI) in 17 patients. CONCLUSIONS: Gliomas growing in the left VPCG are much more likely to cause speech deficits than gliomas infiltrating the IFG, including Broca's area. Lesion extension to the AF connecting frontal to parietal and temporal regions is an important mechanism for the appearance of aphasia. Copyright 2011 Elsevier Srl. All rights reserved. Brain. 2013 Nov;136(Pt 11):3451-60. doi: 10.1093/brain/awt267. Epub 2013 Oct 15.
Damage to the anterior arcuate fasciculus predicts non-fluent speech production in aphasia.
Fridriksson J, Guo D, Fillmore P, Holland A, Rorden C.
with frontal lobe regions, including the pars triangularis. Models that controlled for diadochokinetic rate, picture-word recognition, or executive functioning also revealed a strong relationship between anterior segment involvement and speech fluency. Whole brain analyses corroborated the findings from the region of interest analyses. An additional exploratory analysis revealed that involvement of the uncinate fasciculus adjudicated between Broca's and global aphasia, the two most common kinds of non-fluent aphasia. In summary, the current results suggest that the anterior segment of the left arcuate fasciculus, a white matter tract that lies deep to posterior portions of Broca's area and the sensory-motor cortex, is a robust predictor of impaired speech fluency in aphasic patients, even when motor speech, lexical processing, and executive functioning are included as co-factors. Simply put, damage to those regions results in non-fluent aphasic speech; when they are undamaged, fluent aphasias result. Brain. 2009 Sep;132(Pt 9):2309-16. doi: 10.1093/brain/awp206. Epub 2009 Aug 18.
Long-term neuromotor speech deficits in survivors of childhood posterior fossa tumors: effects of tumor type, radiation, age at diagnosis, and survival years.
Huber JF, Bradley K, Spiegler B, Dennis M.
Children with injury to the central nervous system (CNS) exhibit a variety of language disorders that have been described by members of different disciplines, in different journals, using different descriptors and taxonomies. This paper is an overview of language deficits in children with CNS injury, whether congenital or acquired after a period of normal development. It first reviews the principal CNS conditions associated with language disorders in childhood. It then describes a functional taxonomy of language, with examples of the phenomenology and neurobiology of clinical deficits in children with CNS insults. Finally, it attempts to situate language in the broader realm of cognition and in current theoretical accounts of embodied cognition Pediatr Neurol. 1998 May;18(5):411-4.
Neuromotor speech deficits in children and adults with spina bifida and hydrocephalus.
Huber-Okrainec J, Dennis M, Brettschneider J, Spiegler BJ.
Acquired cerebellar lesions are associated with motor speech deficits. Spina bifida with hydrocephalus (SBH) is a neurodevelopmental disorder that involves significant dysmorphology of the cerebellum. Videotaped narratives produced by 40 children and adults with SBH and their 40 age-matched controls were coded for three motor speech deficits: dysfluency, ataxic dysarthria (articulatory inaccuracy, prosodic excess, and phonatory-prosodic insufficiency) (Brown, Darley, & Aronson, 1970; Darley, Aronson, & Brown, 1969a), and speech rate. Individuals with SBH had more motor speech deficits than controls. Dysfluency was related to an interaction between chronological age and SBH. Speech rate was related independently to chronological age and SBH. Ataxic dysarthria was related to the biology of SBH, and was associated with both physical phenotype (level of spinal cord lesion) and medical history (number of shunt revisions). The data show that developmental as well as acquired lesions of the cerebellum disrupt motor speech, and add to the developmental role of the cerebellum in the automatization of motor skills, including speech. Copyright 2002 Elsevier Science (USA). Cerebellum. 2007;6(1):58-65.
Incidence of mutism, dysarthria and dysphagia associated with childhood posterior fossa tumour.
Cristina Mei, Angela T Morgan
Healthy Development Theme, Murdoch Childrens Research Institute, Parkville, 3052, Melbourne, Australia. Child s Nervous System (Impact Factor: 1.24). 03/2011; 27(7):1129-36. DOI:10.1007/s00381011-1433-x Source: PubMed ABSTRACT Dysarthria and dysphagia are known complications following posterior fossa tumour (PFT) surgery. Outcome studies for these disorders, however, have focused on a select sub-group of children with mutism. Little is known regarding the incidence or features of these impairments in a consecutively admitted sample of children with PFT. This study describes the incidence and features of mutism, dysarthria and dysphagia during the acute post-surgical phase in a consecutive sample of children with PFT, unselected for the presence of mutism. A retrospective medical chart review of children aged 2 to 18 years consecutively admitted with PFT between January 2003 and January 2008 was conducted. Twenty-seven children with PFT were identified. Post-surgical mutism, dysarthria and dysphagia were recorded in 9/27 (33%), 8/27 (30%) and 9/27 (33%) cases, respectively. Dysarthria most commonly involved deficits in articulation; however, impairments in respiration, phonation and prosody were also reported. Dysphagia involved all stages of swallowing (i.e., pre-oral anticipatory, oral preparatory, oral and pharyngeal). Eighty-nine percent of children (8/9) presented with dysphagia at hospital discharge. The incidence of acute presentation of mutism, dysarthria and dysphagia post-surgery was relatively high, affecting around one in three cases. This incidence rate, considered together with the fact that over half of all cases had co-morbid communication or swallowing impairments, suggests that health professionals should be aware of the likelihood of dysarthria and dysphagia presentation in the acute period and consider speech pathology referral where necessary.
Brain Lang. 2001 Dec;79(3):580-600.
increase of insight has brought to the fore that the cerebellum modulates cognitive functioning of at least those parts of the brain to which it is reciprocally connected. This article reviews the recently acknowledged role of the cerebellum in cognition and addresses in more detail experimental and clinical data disclosing the modulatory role of the cerebellum in various nonmotor language processes such as lexical retrieval, syntax, and language dynamics. In agreement with the findings indicating a topographical organization of the cerebellar structures involved in language pathology we advance the concept of a "lateralized linguistic cerebellum." In our view crossed cerebral diaschisis processes, reflecting a functional depression of supratentorial language areas due to reduced input via cerebellocortical pathways, might represent the relevant pathomechanism for linguistic deficits associated with cerebellar pathology.