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Observational Study
. 2025 Jul 11;41(1):231.
doi: 10.1007/s00381-025-06850-0.

Glucocorticoid use in paediatric posterior fossa tumour surgery and the occurrence of postoperative speech impairment

Rebekka Sarup  1   2 , Aske F Laustsen  1   2 , Martin K Sørensen  3   4 , Conor Mallucci  5 , Barry Pizer  6 , Kristian Aquilina  7 , Emanuela Molinari  8 , Magnus Aasved Hjort  9 , Radek Frič  10 , Per Nyman  11 , Magnus Sabel  12   13 , Pelle Nilsson  14 , Algimantas Matukevičius  15 , Peter Hauser  16   17 , Katalin Mudra  16 , Andrea Carai  18 , Julian Zipfel  19 , Eelco Hoving  20 , Kirsten van Baarsen  20 , Vladimír Beneš IIIrd  21 , Andreas Peyrl  22 , Karsten Nysom  2 , Astrid Marie Sehested  2 , Kjeld Schmiegelow  2   4 , Marianne Juhler  1   4   23 , Jonathan K Grønbæk #  24 , René Mathiesen #  2   4
Affiliations
Observational Study

Glucocorticoid use in paediatric posterior fossa tumour surgery and the occurrence of postoperative speech impairment

Rebekka Sarup et al. Childs Nerv Syst. .

Abstract

Purpose: Postoperative speech impairment (POSI) is a core symptom of cerebellar mutism syndrome (CMS) and is a common complication after the resection of paediatric posterior fossa (PF) tumours. Preoperative glucocorticoids (pGC) are considered standard treatment to reduce tumour oedema; in addition, glucocorticoids are often administered intraoperatively (iGC) to reduce both postoperative nausea and vomiting. The study aims to investigate whether the occurrence of POSI may be associated with pGC and iGC.

Methods: In a prospective observational multicentre study, we included children with a PF tumour requiring either resection or open biopsy. The use of pGC and iGC, including drug type and dose, was registered. Postoperative speech status was classified as mutism, reduced speech, or habitual speech, where mutism and reduced speech were considered POSI of higher and lower severity, respectively. Proportional odds logistic regression with adjustment for tumour type, tumour location, and age was used to analyse the occurrence of POSI associated with glucocorticoids (GC).

Results: From August 2014 to November 2024, we recruited 810 children, of whom 605 were included in the primary analysis. We found no association between the use of GC (pGC nor iGC) and the occurrence of POSI. The result did not change when adjusting for tumour type, tumour location, and age. The analysis included both a comparison between using and not using pGC (OR 1.06 [95% CI 0.46 -2.49], reference level: use of pGC) and/or iGC (1.28 [0.58-2.82], reference level: use of iGC), and a dose-response analysis of the occurrence of POSI in relation to doubling the dose of GC (pGC OR 1.28 [0.84-1.98]; iGC OR 1.07 [0.62-1.82]).

Conclusion: Our study did not find evidence of a significant change in the occurrence of POSI with the use of pGC or iGC, but our results alone cannot rule out that the administration of pGC or iGC may have some effect. Therefore, our data do not call for a change in recommendations for the use of GC as protection against the development of POSI.

Trial registration number: Clinicaltrials.gov (NCT02300766). Date of registration: November 25, 2014.

Keywords: Brain neoplasm; Cerebellar mutism syndrome; Intraoperative; Neurosurgery; Postoperative speech impairment; Preoperative.

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Conflict of interest statement

Declarations. Ethics approval: Approved by the Research Ethics Committee of the Capital Region of Denmark (H-6–2014-002). Informed consent: Written informed consent was obtained from the parents. Competing interest: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow diagram of patient exclusion
Fig. 2
Fig. 2
Preoperative glucocorticoid use grouped by country
Fig. 3
Fig. 3
Intraoperative glucocorticoid use grouped by country
See this image and copyright information in PMC

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