Advanced MRI in surgery for posterior fossa tumours
Research type
Research Study
Full title
Advanced magnetic responance imaging in surgery for posterior fossa tumours - predicting post-operative paediatric cerebellar mutism syndrome and surgical guidance to avoid it
IRAS ID
243766
Contact name
Sebastian M Toescu
Contact email
Sponsor organisation
University College London Institute of Child Health
Duration of Study in the UK
2 years, 0 months, 1 days
Research summary
Post-operative paediatric cerebellar mutism syndrome (pCMS) is a well-recognised complication of surgery to remove brain tumours of the cerebellum and fourth ventricle in children. Occurring in around 25% of cases, it is characterised by a delayed onset of mutism and emotional lability, and may comprise motoric and cognitive cerebellar deficits. Transient mutism gives way to prolonged, and often incomplete, recovery. Neuroimaging studies are beginning to reveal anatomical and functional aberrancies in the brain of children with pCMS. The cerebellar efferent pathways are likely to be implicated as a neuroanatomical substrate in the development of pCMS, as shown by a handful of diffusion tractography studies to date. However, the reason this condition develops remains unclear. A lack of bloodflow to structures at the front of the brain may mediate the speech and behavioural deficits seen in pCMS, and is a candidate for a causal mechanism.
This study aims to prospectively image children with pCMS using advanced MRI techniques including diffusion tractography and arterial spin labelling, and to correlate this with clinical descriptions of the syndrome. Patients are already recruited to existing, ethically-approved studies at GOSH/ICH, and the present study simply ties these together in order to ask a slightly different research question, namely: what is the profile of paediatric posterior fossa tumours and pCMS on advanced MRI, and what are their clinical correlates.
All children referred to Great Ormond Street Hospital for Children with a posterior fossa brain tumour will be imaged pre-operatively, post-operatively and at delayed follow-up in accordance with the CCLG Functional Imaging of Tumours study. In tandem with this, data is being collected on various neurosurgical and clinical factors at various time points up to 1 year post-operatively in the context of the Nordic CMS clinical observational cohort. In addition, existing anonymised advanced MRI data on healthy controls from ethically approved projects will be used as a comparator group. The project will form the basis of the CI's PhD thesis, and will run at UCL ICH from March 2018 to March 2020 to allow follow up periods to elapse, and data analysis and write up prior to December 2020.
REC name
London - Harrow Research Ethics Committee
REC reference
18/LO/0501
Date of REC Opinion
19 Mar 2018
REC opinion
Favourable Opinion