Cerebellar Mutism -An Enigma

Introduction
Cerebellar mutism is a syndrome of motor paralysis, behavioural, cognitive impairments especially in large midline tumor of posterior fossa removed via transvermian incision.Seen classically in children,rarely in adults.
Materials and Methods
9 year old child,presented with persistent vomiting for 2 years.He was operated for Pilocytic Astrocytoma of Cerebellum via transvermian approach for gross total resection of this large tumor.From 5th day of surgery he developed mutism and stopped obeying commands.
Another 49 year old female,came with gait imbalance, previously operated for 4 th ventricular ependymoma 4 years ago.She was operated for recurrence of the tumor.Postop patient’s understanding, speech and movements were evaluated to be normal until on 4th day when the patient’s speaking gradually ceased with slowing of movements.
Results-MRI and DTI were suggestive of damage to dentatorubrothalamic tracts. Patients had delayed recovery.
Discussion and Conclusions-
The sequele correspond to delayed recovery.Cognitive impairments may be permanent. Holistic Rehab with speech,physical,occupational therapies are required.Diffusion tensor imaging, Connectomics offer a unique opportunity to study the effect of the posterior fossa tumors on cerebello-cerebral networks and provide new insights into the mechanism of the structural plasticity/approach/reorganization after surgery.Still unresolved issue for treatment ,prevention and mechanisms of etiopathology-lack of definitive evidence.In spite of poor understanding Telovelar approach is better.Future insights with use of new technologies awaited.