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. 2017 Nov 29;19(12):1673-1682.
doi: 10.1093/neuonc/nox135.

Posterior fossa syndrome and long-term neuropsychological outcomes among children treated for medulloblastoma on a multi-institutional, prospective study

Jane E Schreiber  1 , Shawna L Palmer  1 , Heather M Conklin  1 , Donald J Mabbott  1 , Michelle A Swain  1 , Melanie J Bonner  1 , Mary L Chapieski  1 , Lu Huang  1 , Hui Zhang  1 , Amar Gajjar  1
Affiliations

Posterior fossa syndrome and long-term neuropsychological outcomes among children treated for medulloblastoma on a multi-institutional, prospective study

Jane E Schreiber et al. Neuro Oncol. .

Abstract

Background: Patients treated for medulloblastoma who experience posterior fossa syndrome (PFS) demonstrate increased risk for neurocognitive impairment at one year post diagnosis. The aim of the study was to examine longitudinal trajectories of neuropsychological outcomes in patients who experienced PFS compared with patients who did not.

Methods: Participants were 36 patients (22 males) who experienced PFS and 36 comparison patients (21 males) who were matched on age at diagnosis and treatment exposure but did not experience PFS. All patients underwent serial evaluation of neurocognitive functioning spanning 1 to 5 years post diagnosis.

Results: The PFS group demonstrated lower estimated mean scores at 1, 3, and 5 years post diagnosis on measures of general intellectual ability, processing speed, broad attention, working memory, and spatial relations compared with the non-PFS group. The PFS group exhibited estimated mean scores that were at least one standard deviation below the mean for intellectual ability, processing speed, and broad attention across all time points and for working memory by 5 years post diagnosis. Processing speed was stable over time. Attention and working memory declined over time. Despite some change over time, caregiver ratings of executive function and behavior problem symptoms remained within the average range.

Conclusion: Compared with patients who do not experience PFS, patients who experience PFS exhibit greater neurocognitive impairment, show little recovery over time, and decline further in some domains. Findings highlight the particularly high risk for long-term neurocognitive problems in patients who experience PFS and the need for close follow-up and intervention.

Keywords: brain tumor; medulloblastoma; neuropsychological outcomes; posterior fossa syndrome.

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Figures

Fig. 1
Fig. 1
Estimated change in standard scores on performance-based measures over time (years), specifically: (A) General Intellectual Ability, (B) Processing Speed, (C) Broad Attention, (D) Working Memory, and (E) Spatial Relations. Population mean is 100 with a standard deviation of 15 points. The gray bars mark a standard deviation above and below the mean. Group differences were statistically significant (P ≤ 0.01) for all outcomes at 1, 3, and 5 years post diagnosis. There were no statistically significant group differences in change over time (slope).
Fig. 2
Fig. 2
Estimated change in standard scores on caregiver report measures over time (years), specifically: (A) BRIEF Behavior Regulation, (B) BRIEF Metacognition Index, (C) CBCL Internalizing Problems, (D) CBCL Externalizing Problems, and (E) CBCL Total Problems. Standard score mean is 50 with a standard deviation of 10 points. The gray bars mark a standard deviation above and below the mean. Group differences were statistically significant (P < 0.05) at 1 year post diagnosis for BRIEF Behavior Regulation, BRIEF Metacognitive Index, and CBCL Total Problems. Group differences were statistically significant (P < 0.05) at 1 and 3 years post diagnosis for CBCL Externalizing Problems. There were near statistically significant group differences (P = 0.06) in change over time (slope) for BRIEF Metacognitive Index and CBCL Total Problems only.
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