Proximal dentatothalamocortical tract involvement in posterior fossa syndrome

E. Brannon Morris, Nicholas S. Phillips, Fred H. Laningham, Zoltan Patay, Amar Gajjar, Dana Wallace, Frederick Boop, Robert Sanford, Kirsten K. Ness, Robert J. Ogg

Research output: Contribution to journalArticle

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Abstract

Posterior fossa syndrome is characterized by cerebellar dysfunction, oromotor/oculomotor apraxia, emotional lability and mutism in patients after infratentorial injury. The underlying neuroanatomical substrates of posterior fossa syndrome are unknown, but dentatothalamocortical tracts have been implicated. We used pre-and postoperative neuroimaging to investigate proximal dentatothalamocortical tract involvement in childhood embryonal brain tumour patients who developed posterior fossa syndrome following tumour resection. Diagnostic imaging from a cohort of 26 paediatric patients previously operated on for an embryonal brain tumour (13 patients prospectively diagnosed with posterior fossa syndrome, and 13 non-affected patients) were evaluated. Preoperative magnetic resonance imaging was used to define relevant tumour features, including two potentially predictive measures. Postoperative magnetic resonance and diffusion tensor imaging were used to characterize operative injury and tract-based differences in anisotropy of water diffusion. In patients who developed posterior fossa syndrome, initial tumour resided higher in the 4th ventricle (P = 0.035). Postoperative magnetic resonance signal abnormalities within the superior cerebellar peduncles and midbrain were observed more often in patients with posterior fossa syndrome (P = 0.030 and 0.003, respectively). The fractional anisotropy of water was lower in the bilateral superior cerebellar peduncles, in the bilateral fornices, white matter region proximate to the right angular gyrus (Tailerach coordinates 35,-71, 19) and white matter region proximate to the left superior frontal gyrus (Tailerach coordinates-24, 57, 20). Our findings suggest that multiple bilateral injuries to the proximal dentatothalamocortical pathways may predispose the development of posterior fossa syndrome, that functional disruption of the white matter bundles containing efferent axons within the superior cerebellar peduncles is a critical underlying pathophysiological component of posterior fossa syndrome, and that decreased fractional anisotropy in the fornices and cerebral cortex may be related to the abnormal neurobehavioural symptoms of posterior fossa syndrome.

Original languageEnglish (US)
Pages (from-to)3087-3095
Number of pages9
JournalBrain
Volume132
Issue number11
DOIs
StatePublished - Nov 1 2009

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Anisotropy
Brain Neoplasms
Magnetic Resonance Spectroscopy
Mutism
Cerebellar Diseases
Fourth Ventricle
Apraxias
Neoplasms
Parietal Lobe
Diffusion Tensor Imaging
Water
Multiple Trauma
Wounds and Injuries
Diagnostic Imaging
Mesencephalon
Prefrontal Cortex
Neuroimaging
Cerebral Cortex
Axons
Magnetic Resonance Imaging

All Science Journal Classification (ASJC) codes

  • Clinical Neurology

Cite this

Morris, E. B., Phillips, N. S., Laningham, F. H., Patay, Z., Gajjar, A., Wallace, D., ... Ogg, R. J. (2009). Proximal dentatothalamocortical tract involvement in posterior fossa syndrome. Brain, 132(11), 3087-3095. https://doi.org/10.1093/brain/awp241

Proximal dentatothalamocortical tract involvement in posterior fossa syndrome. / Morris, E. Brannon; Phillips, Nicholas S.; Laningham, Fred H.; Patay, Zoltan; Gajjar, Amar; Wallace, Dana; Boop, Frederick; Sanford, Robert; Ness, Kirsten K.; Ogg, Robert J.

In: Brain, Vol. 132, No. 11, 01.11.2009, p. 3087-3095.

Research output: Contribution to journalArticle

Morris, EB, Phillips, NS, Laningham, FH, Patay, Z, Gajjar, A, Wallace, D, Boop, F, Sanford, R, Ness, KK & Ogg, RJ 2009, 'Proximal dentatothalamocortical tract involvement in posterior fossa syndrome', Brain, vol. 132, no. 11, pp. 3087-3095. https://doi.org/10.1093/brain/awp241
Morris EB, Phillips NS, Laningham FH, Patay Z, Gajjar A, Wallace D et al. Proximal dentatothalamocortical tract involvement in posterior fossa syndrome. Brain. 2009 Nov 1;132(11):3087-3095. https://doi.org/10.1093/brain/awp241
Morris, E. Brannon ; Phillips, Nicholas S. ; Laningham, Fred H. ; Patay, Zoltan ; Gajjar, Amar ; Wallace, Dana ; Boop, Frederick ; Sanford, Robert ; Ness, Kirsten K. ; Ogg, Robert J. / Proximal dentatothalamocortical tract involvement in posterior fossa syndrome. In: Brain. 2009 ; Vol. 132, No. 11. pp. 3087-3095.
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