Posterior fossa tumor

P
Post op CT scan show total removal of tumor mass

T

The small opening is the aqueduct shown in the operative field. Basically the tumor extended till the cerebral aqueduct level

This is a case`of 6 yrs old female who presented to us with histroy of headache , dizziness and vomiting of 6 months duration .

O/E she had truncal ataxia , past pointing and intention tremor plus nystagmus

MRI was done and it show Cerebellar tumor involving vermis with extension to hemisphere

Case was operated. Occipital craniectomy was done and 1st dorsal arch was also removed for acess to tumor . Operative findings was a midline tumor soft greyish in the vermis extending to cerebellar hemisphere reaching upto the aqueduct above . Maximal resection was done . There is no post operative complications

Histopathology report say its Medulloblastoma

Post operatively she has developed akinetic mutism after 3 days.

AKINETIC MUTISM in Cerebellar tumor operation

The syndrome generally appears after resection of cerebellar mass primarily in paediatric patients . It has generally delayed onset after relatively normal speech for 1-2 days after surgery . Consists of transient mutism that lasts for 1 day to 6 months and is often followed by dysarthria that recovers slowly over months . It is frequently associated with other neurological signs such as long tract signs and behavioral abnormalities .

Proposed mechanism is that paravermal manipulation may result in damage to dentate nucleus and interpositus nuclei.