{"doi":"10.1093/neuonc/noab030","title":"Clinical features, neurologic recovery, and risk factors of postoperative posterior fossa syndrome and delayed recovery: a prospective study","abstract":"BACKGROUND: Posterior fossa syndrome (PFS) is a known consequence of medulloblastoma resection. Our aim was to clinically define PFS, its evolution over time, and ascertain risk factors for its development and poor recovery. METHODS: Children with medulloblastoma treated at St Jude Children's Research Hospital from 6/2013 to 7/2019 received standardized neurological examinations, before and periodically after radiation therapy. Most (98.3%) were enrolled on the ongoing multi-institutional protocol (SJMB12; NCT01878617). RESULTS: Sixty (34%) of 178 evaluated children had PFS. Forty (23%) had complete mutism (PFS1) and 20 (11%) had diminished speech (PFS2). All children with PFS had severe ataxia and 42.5% of PFS1 had movement disorders. By multivariable analysis, younger age (P = .0005) and surgery in a low-volume surgery center (P = .0146) increased PFS risk, while Sonic Hedgehog tumors had reduced risk (P = .0025). Speech and gait returned in PFS1/PFS2 children at a median of 2.3/0.7 and 2.1/1.5 months, respectively, however, 12 (44.4%) of 27 PFS1 children with 12 months of follow-up were nonambulatory at 1 year. Movement disorder (P = .037) and high ataxia score (P < .0001) were associated with delayed speech recovery. Older age (P = .0147) and high ataxia score (P < .0001) were associated with delayed gait return. Symptoms improved in all children but no child with PFS had normal neurologic examination at a median of 23 months after surgery. CONCLUSIONS: Categorizing PFS into types 1 and 2 has prognostic relevance. Almost half of the children with PFS1 with 12-month follow-up were nonambulatory. Surgical experience was a major modifiable contributor to the development of PFS.","journal":"Neuro-Oncology","year":2021,"id":150026,"datarank":2.412521676355786,"base_score":4.59511985013459,"endowment":4.59511985013459,"self_citation_contribution":0.6892679775201885,"citation_network_contribution":1.7232536988355975,"self_endowment_contribution":0.6892679775201885,"citer_contribution":1.7232536988355975,"corpus_percentile":null,"corpus_rank":null,"citation_count":98,"citer_count":84,"citers_with_citation_signal":55,"citers_with_endowment":55,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9403,"is_data_producer":true,"deposit_databanks":{"ClinicalTrials.gov":["NCT01878617"]},"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2021-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":302804,"name":"Zoltán Patay","orcid":"0000-0003-1479-9864","position":1,"is_corresponding":false},{"id":302801,"name":"Paul Klimo","orcid":"0000-0002-2385-6667","position":2,"is_corresponding":false},{"id":579396,"name":"Jie Huang","orcid":"0000-0002-2466-2469","position":3,"is_corresponding":false},{"id":638052,"name":"Rahul Kumar","orcid":"0000-0001-9671-1146","position":4,"is_corresponding":false},{"id":302802,"name":"Frederick A. Boop","orcid":"0000-0002-2381-3392","position":5,"is_corresponding":false},{"id":638053,"name":"Darcy Raches","orcid":"0000-0002-2125-921X","position":6,"is_corresponding":false},{"id":638054,"name":"Heather M. Conklin","orcid":"0000-0001-8931-4134","position":7,"is_corresponding":false},{"id":638055,"name":"Richa Sharma","orcid":"0000-0003-0462-661X","position":8,"is_corresponding":false},{"id":639353,"name":"Andrea Simmons","orcid":null,"position":9,"is_corresponding":false},{"id":380448,"name":"Zsila Sadighi","orcid":"0000-0003-1686-7760","position":10,"is_corresponding":false},{"id":288898,"name":"Arzu Onar‐Thomas","orcid":"0000-0003-1005-2413","position":11,"is_corresponding":false},{"id":5546,"name":"Amar Gajjar","orcid":"0000-0001-5019-0699","position":12,"is_corresponding":false},{"id":5549,"name":"Giles Robinson","orcid":"0000-0001-7441-9486","position":13,"is_corresponding":false},{"id":638051,"name":"Raja B. Khan","orcid":"0000-0003-3702-7250","position":0,"is_corresponding":true}],"reference_count":33,"raw_metadata":null,"created_at":"2026-07-18T23:43:01.325389Z","pmid":"33823018","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}