Risk factors associated with cerebellar mutism syndrome and late postoperative hydrocephalus following pediatric posterior fossa medulloblastoma surgery

Objective To investigate the risk factors for postoperative complications in pediatric patients with posterior cranial fossa medulloblastoma(MB). Methods A retrospective analysis was performed based on the clinical data of 53 pediatric patients with posterior fossa medulloblastoma treated in Tangdu Hospital, from Dec, 2016 to May, 2024. Various data points, including age, gender, tumor maximum diameter, surgical approach, and complications, were collected and statistically evaluated for an association with cerebellar mutism syndrom(CMS) and late postoperation hydrocephalus (LPH). Results The median age of 53 patients with MB was 6.75 years (interquartile range, 5.4–9.2years). The surgical approach used was the classic telovelar approach for 32 patients, the transvermian approach for 21 patients. Of the 53 children, 10 cases had developed cerebellar mutism syndrom and were included in the CMS group, with 43 patients in the non-CMS group. 9 cases had developed late postoperative hydrocephalus, Four patients were asymptomatic with normal cerebrospinal fluid (CSF) pressure on lumbar puncture and were managed conservatively with close clinical monitoring. the remaining five patients exhibited symptoms of elevated intracranial pressure—including headache and nausea—and demonstrated elevated CSF pressure on lumbar puncture; all underwent ventriculoperitoneal shunt placement. Statistical analysis revealed that tumor maximum diameter (OR 16.97, P = 0.011), transvermian approach (OR 97.02, P = 0.017) were independent risk factors for postoperative cerebellar mutism syndrome. Statistical analysis revealed that CSF-related complications (OR 212.7, P = 0.006), were independent risk factors for LPH. Conclusion Our CMS rate is comparable to those reported in the literature. Despite the inherent limitations of the retrospective study design, our findings indicate that CMS was not only associated with the transvermian approach but also significantly linked to tumor’s maximum diameter. Furthermore, CSF-related complications were identified as independent risk factors for LPH.