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Recovery of Lower Cranial Nerve Function after Surgery for Medullary Brainstem Tumors

Jallo, George I. M.D.; Shiminski-Maher, Tania M.S.; Velazquez, Linda M.S.; Abbott, Rick M.D.; Wisoff, Jeff M.D.; Epstein, Fred M.D.

doi: 10.1227/01.NEU.0000144782.39430.12
Clinical Studies: TUMOR

OBJECTIVE: Although optimal treatment for intrinsic focal tumors of the medulla remains controversial, many surgeons advocate radical surgery for patients with these tumors. Postoperative surgical morbidity may include loss of lower cranial nerve function and significant motor deficits. Recovery of lower cranial nerve dysfunction after radical surgery has not been reported previously.

METHODS: Forty-one children and adolescents with tumors involving the medulla underwent operations between 1986 and 1997. Nineteen (46%) of these patients experienced loss of lower cranial nerve function requiring tracheostomy, ventilator support, and feeding gastrostomy. A retrospective analysis of this patient population and the time to cranial nerve recovery was undertaken.

RESULTS: Thirteen (68%) of the 19 patients with loss of lower cranial nerve function had full recovery of lower cranial nerve function. Two patients (11%) have had significant improvement in their lower cranial nerve function, and four patients (21%) have remained without lower cranial nerve function.

CONCLUSION: Lower cranial dysfunction is common after surgery for intrinsic medullary tumors. However, the majority of patients who require tracheostomy or gastrostomy tubes will recover cranial nerve function.

Division of Pediatric Neurosurgery, Johns Hopkins University, Baltimore, Maryland (Jallo)

Division of Pediatric Neurosurgery, Institute for Neurology and Neurosurgery, Beth Israel Medical Center, New York, New York (Shiminski-Maher, Velazquez, Abbott, Epstein)

Division of Pediatric Neurosurgery, New York University Medical School, New York, New York (Wisoff)

Reprint requests: George I. Jallo, M.D.,Division of Pediatric Neurosurgery, Johns Hopkins Hospital, 600 North Wolfe Street, Harvey 811, Baltimore, MD 21287. Email:

Received, June 30, 2004.

Accepted, August 27, 2004.

Copyright © by the Congress of Neurological Surgeons