Recommended reading of the paper
After posterior fossa surgery, cerebellar mutism may occur predominantly in children. It is characterized by motor, speech, and behavioral disorders and it may affect significantly the postoperative course of those patients. However, little is known about the neurophysiological basis of cerebellar mutism and even less about intraoperative methods to predict or even prevent such conditions. The authors performed a systematic review of the literature to address this topic. They identified a lack of knowledge and they lanced the call to search for developing new methods.
This paper may recommended for readings as:
- It describes the role of the dentato-thalamic-cortical (DTC) pathway in cerebellar mutism and the posterior fossa syndrome.
- Two pilot studies were identified which described first attempts to investigate cerebellar projections intraoperatively.
- The authors discuss the necessity to develop new techniques to map and monitor the DTC pathways.
In summary, this paper may motivate the readers to learn more about basic neurophysiology and to take those approaches to the operating room aiming to improve surgical guidance.
Mottolese C, Richard N, Harquel S, Szathmari A, Sirigu A, Desmurget M(2013)Mapping motor representations in the human cerebellum. Brain 136(1):330–342
Mottolese C, Szathmari A, Beuriat PA, Sirigu A, Desmurget M (2015) Sensorimotor mapping of the human cerebellum during pineal region surgery. Neurochirurgie 61(2–3):101–105
Iwata NK, Ugawa Y (2005) The effects of cerebellar stimulation on the motor cortical excitability in neurological disorders: a review. Cerebellum. 4(4):2018–2023.
Strick PL, Dum RP, Fiez JA (2009) Cerebellum and nonmotor function. Annu Rev Neurosci 32:413–434. https://doi.org/10.1146/annurev.neuro.31.060407.125606
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ISIN SEP Recommendations
- This article reviews and forms recommendations for intraoperative SEPs.
- It endorses SEP optimization to enhance surgical feedback speed and accuracy.
- It supports an adaptive warning criterion to adjust for baseline drift and variability.