Posterior Fossa Syndrome

Posterior fossa syndrome is a condition that is the result after surgery of a brain tumor removal in the posterior fossa. The posterior fossa, or the cerebellum, is at the rear of the skull. This condition is also called the cerebellar mutism syndrome. Posterior fossa syndrome is made up of many different symptoms.

Medulloblastomas are the most common type of malignant brain tumors in children. Medulloblastomas occur in the posterior fossa. About 25% of brain tumor removals in the posterior fossa will result in a child developing posterior fossa syndrome.

Posterior fossa syndrome only occurs in children. It is more likely that younger children will develop this condition. You are also at higher risk depending on where your brain tumor is located. If the brain tumor is located in two halves of the cerebellum, the brain tumor involves both halves of the cerebellum, or it extends into the brainstem. The size of the brain tumor can also affect the risk of developing posterior fossa syndrome. The larger the brain tumor the higher the risk.

Symptoms

Symptoms can be immediate after surgery. Most commonly symptoms start to appear one to two days post operation. Sometimes symptoms are delayed, but usually are developed within a week post operation. The most common symptom that can happen immediately after surgery is loss of speech, or mutism. Sometimes a child will be able to say a few words immediately after surgery, then lose their speech, others may not be able to speak at all after surgery. Communication skills may decline as well. Speech may improve within a few days up to a few months, but sometimes speech difficulties don’t fully resolve.

Other symptoms are weakness in one side of the body, difficulty swallowing, facial paralysis on one side, or incontinence. Your child may have changes in their moods. It is normal for someone with posterior fossa syndrome to have dysphoria, apathy, distress, to be inconsolable, tearful, giggle, be easily distracted, or be overly irritable. Poor balance and difficulty walking steadily are also common symptoms. Having trouble sitting on their own, or even fine gross motor skills such as using a utensil or pencil can become difficult. Symptoms can last months to years. How long symptoms last depends on severity and how the child responds to treatment.

Treatment & Recovery

The more severe the symptoms the longer the symptoms will last. The recovery of each child with posterior fossa syndrome is different. Treatment will be compiled with a team of specialists on how best to support your child and lessen their symptoms. One of the specialists your child may need to see is a speech and language therapist. A speech and language therapist will help with speech, language, communication, swallowing, and drinking difficulties your child may have. Mutism can vary from case to case of posterior fossa syndrome. All children with posterior fossa syndrome have had return of their speech. Speech may be altered after surgery such as the pitch may be altered, the speech may be slower, or the intonation can be different. Your child may also speak less than before. It is normal for speech to return gradually and not all at once. Some children who can’t communicate verbally at once, may be able to communicate with gestures such as nodding their head or shaking their head.

A physiotherapist will help your child maximize their strength, balance, and coordination. In most cases of posterior fossa syndrome children are usually able to walk independently in time. It is common though for a child to have ongoing problems with balance, coordination, fine and gross motor skills.

Occupational therapy can help your child regain independence in everyday tasks. This could be eating with a utensil, tying their shoes, getting dressed on their own. Tasks that they once were able to do, relearning them to be able to do them on their own again.

A psychologist can also help support your child emotionally, and with behavioral issues. Mood swings and irritability is common with posterior fossa syndrome. Your child may be scared especially if they cannot communicate or talk at all. At first a child may come off as being reluctant or unwilling, this is all normal. Your team of healthcare providers will be able to help you navigate these mood swings and the reluctant behavior to help your child.

Takeaway

Posterior fossa syndrome is a complication from having a brain tumor removal done in the posterior fossa part of the brain. Younger children are at higher risk of developing this complication. Posterior fossa syndrome is not necessarily curable, but it is definitely treatable. There can be long term lasting symptoms of this condition, but in some cases symptoms can disappear within a few months after they start. Recovery for every child with posterior fossa syndrome is different.