Association between cerebral perfusion and paediatric postoperative cerebellar mutism syndrome after posterior fossa surgery—a systematic review

Narjes Ahmadian*, K. M. van Baarsen, P. A.J.T. Robe, E. W. Hoving

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

1 Citation (Scopus)


Background: Paediatric postoperative cerebellar mutism syndrome (ppCMS) is a common complication following the resection of a cerebellar tumour in children. It is hypothesized that loss of integrity of the cerebellar output tracts results in a cerebello-cerebral “diaschisis” and reduced function of supratentorial areas of the brain. Methods: We performed a systematic review of the literature according to the PRISMA guidelines, in order to evaluate the evidence for hypoperfusion or hypofunction in the cerebral hemispheres in patients with ppCMS. Articles were selected based on the predefined eligibility criteria and quality assessment. Results: Five studies were included, consisting of three prospective cohort studies, one retrospective cohort study and one retrospective case control study. Arterial spin labelling (ASL) perfusion MRI, dynamic susceptibility contrast (DSC) perfusion MRI and single photon emission computed tomography (SPECT) were used to measure the cerebral and cerebellar tissue perfusion or metabolic activity. Reduced cerebral perfusion was predominantly demonstrated in the frontal lobe. Conclusions: This systematic review shows that, after posterior fossa tumour resection, cerebral perfusion is reduced in ppCMS patients compared to patients without ppCMS. Well-powered prospective studies, including preoperative imaging, are needed to ascertain the cause and role of hypoperfusion in the pathophysiology of the syndrome.

Original languageEnglish
Pages (from-to)2743-2751
Number of pages9
JournalChild's Nervous System
Issue number9
Publication statusPublished - Sept 2021


  • Arterial spin labelling (ASL)
  • Cerebral perfusion
  • Dynamic susceptibility contrast (DSC)
  • Paediatric postoperative cerebellar mutism syndrome (ppCMS)
  • Posterior fossa syndrome
  • Single photon emission tomography (SPECT)
  • Prospective Studies
  • Humans
  • Postoperative Complications/diagnostic imaging
  • Cerebellum/diagnostic imaging
  • Cerebrovascular Circulation
  • Case-Control Studies
  • Perfusion
  • Cerebellar Diseases/diagnostic imaging
  • Retrospective Studies
  • Child
  • Mutism/diagnostic imaging


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