The Research Trends of Post-operative Pediatric Cerebellar Mutism Syndrome: A Bibliometric Analysis (1999-2022)

The Research Trends of Post-operative Pediatric Cerebellar Mutism Syndrome: A Bibliometric Analysis (1999-2022) | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Research Trends of Post-operative Pediatric Cerebellar Mutism Syndrome: A Bibliometric Analysis (1999-2022) Qingtian Liang, Zuqing Wu, Sihan Zhu, Yizhi Du, Zhuqing Cheng, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4443326/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 3 You are reading this latest preprint version Abstract Background Post-operative pediatric cerebellar mutism syndrome (ppCMS) is a common neurological complication characterized by delayed onset mutism, emotional lability, hypotonia, and oropharyngeal dysfunction following resection of a posterior fossa tumor in children. The objective of this study is to visually depict the knowledge structure and pinpoint research hotspots within the field using bibliometric analysis. Method Publications related to ppCMS from 1999 to 2022 were searched on the Web of Science Core Collection (WoSCC) database. VOSviewer, R package, “bibliometrix”, and CiteSpace were used to draw and analyze corresponding visualization maps. Results 410 articles from 52 countries led by the United States of America (USA) and England were included. The number of published papers is on the rise in general. Hospital for Sick Children (Canada), St. Jude Children’s Research Hospital (USA), University Toronto (Canada), Texas Children’s Hospital (USA), and Children’s National Hospital (USA) are the main research institutions. Child’s Nervous System is the most popular and the most co-cited journal in this domain. These publications come from 2091 authors. Gajjar, A. has published the most papers, and the papers authored by Schmahmann, J.D. have been co-cited the most. The mechanisms, risk factors, and clinical manifestations of ppCMS occurrence and development are the main topics in this field. The most commonly used keywords are medulloblastoma, posterior fossa syndrome, cerebellar mutism, cerebellum, and children. Conclusion This is the first bibliometric analysis to comprehensively overview the active research areas and development of ppCMS, which will provide a reference for scholars studying this field. bibliometrics post-operative cerebellar mutism syndrome posterior fossa syndrome cerebellar mutism cerebellar mutism syndrome Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 Figure 10 Figure 11 1. Introduction In early 1958, Daly, D.D., and Love, J.G. coined the term akinetic mutism (AM) to describe the absence of speech following posterior fossa tumor (PFT) surgery [ 1 ]. Over the ensuing six decades, various terms such as cerebellar mutism (CM), cerebellar mutism syndrome (CMS), cerebellar mutism and subsequent dysarthria (MSD), posterior fossa syndrome (PFS), transient cerebellar mutism (TCM), and cerebellar cognitive affective syndrome (CCAS) have been employed in different studies [ 2 – 7 ]. To address the confusion surrounding the postoperative cerebellar mutism syndrome (pCMS), Gudrunardottir, T. et al [ 8 ] proposed a new definition under the "modified Delphi" methodology: "Post-operative pediatric CMS is characterized by delayed onset mutism/reduced speech and emotional lability after cerebellar or 4th ventricle tumor surgery in children. Additional common features include hypotonia and oropharyngeal dysfunction/dysphagia. It may frequently be accompanied by cerebellar motor syndrome, cerebellar cognitive affective syndrome, brain stem dysfunction including long tract signs, and cranial neuropathies. The mutism is always transient, but recovery from CMS may be prolonged. Speech and language may not return to normal, and other deficits of cognitive, affective, and motor function often persist". The reported incidence of ppCMS ranges from 17.5–32.1% [ 9 – 14 ]. Lewison, G. astutely likened bibliometrics to scientific papers in the same way epidemiology is to patients [ 15 ]. On one hand, bibliometrics offers both quantitative and qualitative insights into the interconnections among various elements such as countries, institutions, journals, authors, papers, keywords, and more [ 16 , 17 ]. On the other hand, it serves as a valuable tool for discerning the evolutionary trends within a specific field [ 17 ]. Popular bibliometric tools for domain visualization include VOSviewer, the R package "bibliometrix," and Citespace [ 18 , 19 ]. Numerous authors have delved into the exploration of postoperative pediatric cerebellar mutism syndrome (ppCMS), scrutinizing its anatomical substrates, pathophysiology, risk factors, and potential treatments [ 20 – 24 ]. However, the conventional categorization and synthesis of literature are profoundly dependent on the subjective judgments of authors, thereby presenting formidable challenges in conducting comprehensive and precise analyses of a substantial volume of literature, as well as in replicating such evaluations. In addition, it is hard to know the trends in a certain field when times change. Furthermore, a comprehensive investigation into various factors such as countries, institutions, journals, authors, references, citation bursts, and keywords has not been conducted on ppCMS to date [ 17 ]. To address this gap, we employ bibliometric methodology to quantify and visualize published papers in this domain from 1999 to 2022. The primary objective is to unveil research trends and hotspots in ppCMS, facilitating researchers in pursuing further in-depth studies. 2. Methods 2.1 Search Strategy In order to search the relevant literature extensively, we conducted a literature search (used by Pettersson, S.D. et al [ 24 ] in a systematic review and a meta-analysis) on the Web of Science Core Collection (WoSCC) database ( https://www.webofscience.com/wos/woscc/basic-search ) on 14 October 2023. The search strategy is TS = ((posterior fossa syndrome OR mutism OR dysarthria) AND (tumor* OR medulloblastoma* OR ependymoma* OR astrocytoma*) AND (pediatric* OR child* OR teenager* OR adolescent*)) AND LA = (English), and only “articles” and “reviews” were included (Fig. 1 ). 2.2 Data Analysis We employed powerful bibliometric tools to comprehensively analyze postoperative pediatric cerebellar mutism syndrome (ppCMS) publications. VOSviewer (version 1.6.19) is a powerful software tool for exploring the relationships between various aspects of research publications based on network data in three representations: network, overlay, or density visualization [ 18 , 25 ]. In our study, VOSviewer was mainly used to visualize the analysis of country and institution, journal and co-cited journal, author and co-cited author, co-cited references, and keyword co-occurrence through network and overlay visualization. Within the network visualization map, individual nodes correspond to distinct parameters, including countries/regions, institutions, journals, authors, or keywords. The node size is indicative of its strength, encompassing factors such as the number of publications, citations, and occurrences. Concurrently, the thickness of the links denotes the strength of network associations. Color-coded nodes and links are employed to denote clusters and connections, respectively, with clusters sharing the same color automatically designated to closely related terms [ 26 ]. Bibliometrix (version 4.1.3) ( https://www.bibliometrix.org ) is a package that needs to be utilized in the R programming environment [ 18 ]. After data import and conversion to R format, it was applied to construct a global distribution network of publications of ppCMS and to create a three-field plot that reflects the associations among author country, journals, and affiliations. CiteSpace (version 6.1.R6) emerged as another valuable tool for bibliometric and content analytic visualizations [ 27 ]. Our utilization of CiteSpace included mapping the dual-map overlay of journals and identifying references with citation bursts. If a paper suddenly shows a sharp increase in citations, namely citation bursts, an appropriate explanation is that the paper has hit on an important part of the field over a period of time [ 28 ]. In tandem, Microsoft Office Excel 2021 was employed to analyze the trend of annual publication numbers. This integrated approach allowed for a comprehensive and insightful exploration of the ppCMS research landscape. 3. Results 3.1 Quantitative Analysis of Publication Utilizing our search formula, we identified a total of 410 studies on postoperative pediatric cerebellar mutism syndrome (ppCMS) from 1999 to 2022, comprising 334 "articles" and 76 "reviews." Analyzing the annual growth rate of publications, we categorized the entire timeframe into three periods: Period I (1999–2005), Period II (2006–2019), and Period III (2020–2022). As depicted in Fig. 2 , the average annual publication number during Phase I is 8.29. Except for 2001, each year in Phase I yielded fewer than 10 publications. In Phase II, the number of publications fluctuates between 14 and 23, with an average annual count of 17.86, notably higher than that of Phase I. In 2020, the publication number surged to 32, marking the first instance of surpassing 30 papers annually. Phase III exhibits an average annual publication number of 34. 3.2 Country and Institutional Analysis Table 1 Top 10 countries and institutions on the research of postoperative pediatric cerebellar mutism syndrome. Rank Country Counts Instituition Counts 1 USA (North America) 141(34.39%) Hospital for Sick Children (Canada) 20(4.88%) 2 England (Europe) 38(9.27%) St. Jude Children’s Research Hospital (USA) 18(4.39%) 3 Canada (North America) 34(8.29%) University of Toronto (Canada) 15(3.66%) 4 Germany (Europe) 34(8.29%) Texas Children’s hospital (USA) 13(3.17%) 5 Italy (Europe) 33(8.05%) Children’s National Hospital (USA) 11(2.68%) 6 Australia (Oceania) 25(6.10%) Alder Hey Children’s NHS Foundation Trust (England) 10(2.44%) 7 Netherlands (Europe) 22(5.37%) Massachusetts General Hospital (USA) 10(2.44%) 8 France (Europe) 18(4.39%) Royal Children’s Hospital (Australia) 9(2.20%) 9 Belgium (Europe) 14(3.41%) Stanford University (USA) 9(2.20%) 10 India (Asia) 14(3.41%) University of Antwerp (Belgium) 9(2.20%) A total of 52 nations and 653 institutions actively contributed to the pool of publications on postoperative pediatric cerebellar mutism syndrome (ppCMS). Among the top 10 countries, Europe (n = 6) and North America (n = 2) predominate, with representation extending across Europe, North America, Asia, and Australia (Table 1 ). The United States leads with the highest number of publications (n = 141, 34.39%), followed by Germany (n = 34, 8.29%), Canada (n = 34, 8.29%), and England (n = 38, 9.27%). Notably, the combined publications from these four countries surpass half of the total (n = 247, 60.24%). To visualize international collaboration, we constructed a collaborative network involving 37 countries with publication numbers equal to or greater than 2. The network, based on publication quantity and correlation, revealed robust international cooperation. For instance, the United States exhibited close collaboration with Europe, Canada, Australia, and China, reflecting a dynamic landscape of active international partnerships (Fig. 3 ). The Top 10 institutions are located in 5 countries, with three of them located in Europe and two located in North America. Each of the top 5 institutions published more than 10 papers. Then, we derived a collaborative network based on the quantity and correlation of publications of each institution, selecting 31 institutions for visualization based on the minimum number of publications equal to 5 (Fig. 4 ). As depicted in Fig. 4 , the cooperation between Hospital for Sick Children (Canada), University of Toronto (Canada), and Texas Children’s Hospital (USA) is very close. What’s more, there is active cooperation between St. Jude Children’s Research Hospital (USA), Hospital for Sick Children (Canada), and Texas Children’s Hospital (USA). 3.3 Journals and Co-cited Journals Table 2 Top 10 journals and Top 10 co-cited journals for research of postoperative pediatric cerebellar mutism syndrome. Rank Journal Count IF Q Co-cited Journal Co-citation IF Q 1 Child's Nervous System 67(16.34%) 1.4 Q3 Child's Nervous System 1162 1.4 Q3 2 Pediatric Neurosurgery 16(3.90%) 0.7 Q4 Journal of Neurosurgery 852 4.1 Q1 3 Pediatric Neurology 16(3.90%) 3.8 Q1 Neurosurgery 649 4.8 Q1 4 Journal of Neurosurgery-pediatrics 14(3.41%) 1.9 Q3 Journal of Clinical Oncology 575 45.3 Q1 5 Neuro-oncology 11(2.68%) 15.9 Q1 Brain 531 14.5 Q1 6 Pediatric Blood & Cancer 11(2.68%) 3.2 Q2 Pediatric Neurosurgery 491 0.7 Q4 7 Cerebellum 10(2.44%) 3.5 Q2 Neuro-oncology 324 15.9 Q1 8 Journal of Neuro-oncology 9(2.20%) 3.9 Q2 Neurology 324 9.9 Q1 9 World Neurosurgery 8(1.95%) 2 Q3 International Journal of Radiation Oncology Biology Physics 279 7 Q1 10 Journal of Neurosurgery 7(1.71%) 4.1 Q1 Journal of Neuro-oncology 267 3.9 Q2 Publications related to ppCMS were published in 161 journals. Child’s Nervous System published most papers (n = 67, 16.34%), followed by Pediatric Neurosurgery (n = 16, 3.90%), and Pediatric Neurology (n = 16, 3.90%). Among the top 10 journals, Neuro-oncology (IF = 15.9) has the greatest impact factor among the top 10 journals, followed by Journal of Neurosurgery (IF = 4.1). After that, we mapped the journal network and filtered 33 journals using the criterion that the minimum number of pertinent publications should be equal to 3. (Fig. 5 A). As can be seen in Fig. 5 A, Child’s Nervous System has active citation relationships with World Neurosurgery , Journal of Neurosurgery , Pediatric Neurology , Pediatric Neurosurgery , Journal of Neuro-oncology , and Pediatric Blood & Cancer . As shown in Table 2 , among the top 10 co-cited journals, Child’s Nervous System was the most cited journal (Co-citation = 1162), followed by Journal of Neurosurgery (Co-citation = 852), Neurosurgery (Co-citation = 649), Journal of Clinical Oncology (Co-citation = 575), and Brain (Co-citation = 531). Furthermore, the impact factor of the Journal of Clinical Oncology is the highest (IF = 45.3), followed by Neuro-oncology (IF = 15.9). To map the co-citation network, journals with a minimum co-citation of 100 were filtered out (Fig. 5 B). As illustrated in Fig. 5 B, Child's Nervous System shows positive co-citation connections with both Neurosurgery and the Journal of Neurosurgery. The dual-map overlay of journals displays clusters of citing journals on the left and clusters of cited journals on the right, illustrating the citation links between journals and co-cited journals [ 16 ]. As depicted in Fig. 6 , the pink paths are the main citation paths, which represent the research published in Molecular, Biology, Genetics (pink path 1), Health, Nursing, Medicine (pink path 2), and Psychology, Education, Social (pink path 3) are mainly cited by literature in Neurology, Sports, and Ophthalmology. The research published in Psychology, Education, and Social (the green path) is also cited by the literature in Medicine, Medical, and Clinical. We also created a three-field plot (San-key diagram) of country, journal, and affiliation. As shown in Fig. 7 , the publications from the United States are mainly published in Child’s Nervous System , Neuro-oncology , Journal of Neurosurgery-pediatrics , and Pediatric Neurology . On the other hand, the top 4 affiliations are mostly published papers in Child’s Nervous System and Neuro-Oncology . 3.4 Authors and Co-Cited Authors Table 3 Top 10 authors and co-cited authors on the research of postoperative pediatric cerebellar mutism syndrome. Rank authors count Co-Cited Authors citations 1 Gajjar, A. 13 Schmahmann, J.D. 246 2 Mabbott, D.J. 10 Pollack, I.F. 210 3 Kumar, R. 9 Catsman-berrevoets, C.E. 151 4 Pizer, B. 9 Ersahin, Y. 135 5 Avula, S. 8 Gudrunardottir, T. 133 6 Bouffet, E. 8 Robertson, PL. 131 7 Conclin, H.M. 7 Riva, D. 125 8 Juhler, M. 7 De Smet, H.J. 97 9 Marien, P. 7 Wells, E.M. 94 10 Packer, R.J. 7 Mulhern R.K. 93 In all, 2091 authors took part in the research of ppCMS. Among the top 10 authors, two authors published more than or equal to 10 papers (Table 3 ). We constructed a collaborative network based on authors with more than or equal to four published papers (Fig. 7 A). Gajjar, A. had the largest node because he published the most related publications. Furthermore, we noticed that several writers worked closely together. Gajjar, A., for instance, worked closely with Palmer, S.L.; Marien, P. actively collaborated with De Deyn, P.P.; and Pizer, B. actively worked with Kumar, R. Seven authors were co-cited more than 100 times out of the 6974 co-cited authors. Schmahmann, J.D. (n = 246) is the most co-cited author, followed by Pollack, I.F. (n = 120), and Catsman-berrevoets, C.E. (n = 151). To map co-citation network graphs, authors with at least 50 co-citations were filtered (Fig. 8 B). As illustrated in Fig. 8 B, there are ongoing partnerships between many co-cited writers. Schmahmann, J.D., for instance, collaborated closely with Pollack, I.F., Stoodley, C.J., and Riva, D. 3.5 Co-Cited References Table 4 Top 10 co-cited references on the research of postoperative pediatric cerebellar mutism syndrome. Rank Co-cited reference Citations 1 pollack if, 1995, neurosurgery , v37, p885, doi 10.1227/00006123-199511000-00006 [ 29 ] 126 2 robertson pl, 2006, j neurosurg , v105, p444, doi 10.3171/ped.2006.105.6.444 [ 3 ] 125 3 rekate hl, 1985, arch neurol-chicago , v42, p697, doi 10.1001/archneur.1985.04060070091023 [ 2 ] 79 4 levisohn l, 2000, brain , v123, p1041, doi 10.1093/brain/123.5.1041 [ 30 ] 79 5 catsman-berrevoets ce, 1999, j neurol neurosur ps , v67, p755, doi 10.1136/jnnp.67.6.755 [ 31 ] 77 6 riva d, 2000, brain , v123, p1051, doi 10.1093/brain/123.5.1051 [ 32 ] 77 7 schmahmann jd, 1998, brain, v121, p561, doi 10.1093/brain/121.4.561 [ 7 ] 73 8 dailey at, 1995, j neurosurg , v83, p467, doi 10.3171/jns.1995.83.3.0467 [ 33 ] 68 9 vandongen hr, 1994, neurology , v44, p2040, doi 10.1212/wnl.44.11.2040 [ 4 ] 65 10 morris eb, 2009, brain , v132, p3087, doi 10.1093/brain/awp241 [ 34 ] 63 There are 9348 co-cited references on the research of ppCMS from 1999 to 2022. Two references were co-cited more than 100 times, and all of the top 10 co-cited references were co-cited at least 63 times (Table 4 ). For the purpose of creating the co-citation network map (Fig. 9 ), we chose references with at least 30 co-citations. According to Fig. 9 , “Pollack, I.F., 1995, neurosurgery” shows active co-cited relationships with “Robertson, P.L., 2006, J Neurosurg ”, “Rekate, H.L., 1985, Arch Neurol-Chicago ”, and “Catsman-berrevoets, C.E., 1999, J Neurol Neurosur Ps ”. 3.6 Reference with Citation Bursts Table 5 The main research content of the 15 references with strong citation bursts. Rank Strength Main research content 1 17.39 Form a new definition of post-operative pediatric cerebellar mutism syndrome [ 8 ]. 2 14.6 Apply a CMS questionnaire into two clinical trials to prospectively detect incidence, severity, and possible causes of cerebellar mutism occurrence [ 3 ]. 3 11.72 A prospective study to investigate presurgical and clinical factors associated with cerebellar mutism syndrome occurrence [ 35 ]. 4 9.42 A retrospective study to detect neuroradiographic features of cerebellar mutism syndrome, which was based on the preoperative, immediate postoperative, and 1-year postoperative magnetic resonance images [ 36 ]. 5 8.97 A review of clinical, neuroradiographic, neuropsychological findings, and possible mechanisms associated with cerebellar mutism syndrome [ 37 ]. 6 8.61 The diffusion abnormalities involving the proximal efferent cerebellar pathway were significantly associated development of posterior fossa syndrome [ 38 ]. 7 8.33 The damage of the proximal dentatothalamocortical tract is an important mechanism to understand the occurrence of posterior fossa syndrome [ 34 ]. 8 8.18 A review with respect to incidence, anatomical substrates, pathophysiology, risk factors, surgical considerations, treatment options, prognosis, and prevention of cerebellar mutism [ 22 ]. 9 7.46 A critical review to reevaluate the information regarding motor speech production post-mutism and chart a mode of recovery of it [ 39 ]. 10 6.96 An interesting case has been reported and literatures related to the pathophysiologic mechanism of cerebellar mutism have been reviewed [ 23 ]. 11 6.87 Effects of magnetic resonance imaging to elucidate cauces and potential pathophysiological machanisms of posterior fossa syndrome [ 40 ]. 12 6.65 The cognitive and behavioral impairments in children after cerebellar astrocytoma surgery [ 41 ]. 13 6.65 A prospective study to compare the severity of speech deficits between tumor survivors with transient cerebellar mutism and those without [ 42 ]. 14 6.59 A pre-operative scoring system for predicting risk of postoperative pediatric cerebellar mutism syndrome [ 43 ]. 15 6.48 A review to focus on behavioral and emotional impairments of children with posterior fossa syndrome [ 44 ]. The time span of citation bursts is represented by red bars in Fig. 10 . By means of CiteSpace, we chose 15 references with the strongest citation bursts. As depicted in Fig. 10 , citation bursts for references emerged starting in 2005 and ending in 2018. “ Consensus paper on post-operative pediatric cerebellar mutism syndrome: the Iceland Delphi results ” written by Gudrunardottir, T. et al, had the strongest citation burst (strength = 17.39). The citation burst occurred from 2017 to 2022. In short, the burst strength of these 15 references ranged from 6.48 to 17.39, and the time span was from 4 to 6 years. Table 5 summarizes the main research contents of the 15 references in the order of citation strengths. 3.7 Hotspots and Frontiers Table 6 Top 15 keywords on the research of postoperative pediatric cerebellar mutism syndrome. Rank Keywords Counts 1 Medulloblastoma 83 2 Posterior fossa syndrome 61 3 Cerebellar mutism 47 4 Cerebellum 41 5 Children 38 6 Posterior fossa 36 7 Cerebellar mutism syndrome 35 8 Mutism 33 9 Brain tumor 29 10 Posterior fossa tumor 22 11 Cognition 18 12 Pediatric 17 13 Dysarthria 14 14 Child 13 15 Neurosurgery 13 Research hotspots in a particular topic could be swiftly identified by using co-occurrence analysis of keywords[ 16 ]. Table 6 lists the top 15 high-frequency keywords in the research of ppCMS. Among these keywords, medulloblastoma appeared 83 times, representing the main research direction of ppCMS. We conducted cluster analysis after filtering keywords with more than or equal to 6 occurrences by using VOSviewer (Fig. 11 A). As displayed in Fig. 11 A, we obtained six clusters representing six research directions. (1) The keywords in the red cluster consist of ataxia, brain tumor, cerebellar mutism syndrome, child, diffusion tensor imaging, oncology, pediatric brain tumor, pediatric neurosurgery, pediatrics, posterior fossa surgery, posterior fossa tumor, and speech. (2) The keywords in the green cluster consist of astrocytoma, dysarthria, mutism, outcome, pediatric, posterior fossa tumors, and risk factors. (3) The keywords in the blue cluster consist of chemotherapy, magnetic resonance imaging, medulloblastoma, radiotherapy, surgery, and treatment. The keywords in the yellow cluster consist of children, ependymoma, fourth ventricle, hydrocephalus, and posterior fossa. (5) The keywords in the purple cluster consist of cerebellar cognitive affective syndrome, neurosurgery, and posterior fossa syndrome. (6) The keywords in the cyan cluster consist of cerebellum, cognition, MRI, and neuropsychology. 4. Discussion 4.1 Gerneral Information The average publications in the three periods were 8.29 (1999–2005), 17.86 (2006–2019), and 34 (2020–2022), indicating a notable increase in scholarly attention to postoperative pediatric cerebellar mutism syndrome (ppCMS) in recent years. The United States stands out as the primary contributor, with 141 publications (34.39%), surpassing the combined output of Germany, Canada, and England. Close collaboration is observed among North America, Europe, and Oceania, particularly evident in the strong ties between U.S. and Canadian institutions. Child's Nervous System , with an impact factor of 1.4 (Q3), emerged as the leading journal in ppCMS research. Neuro-oncology , boasting an impact factor of 15.9 (Q1), leads the journal landscape, followed by the Journal of Neuro-oncology (impact factor 3.9, Q2). The co-cited journals, predominantly Q1 high-impact publications, provide robust support for ppCMS research. Clinical research dominates the current landscape, with major contributions from authors such as Gajjar, A., Mabbott, D.J., Kumar, R., and Pizer, B. Gajjar's early work in 2006 applied a CMS questionnaire to clinical trials, highlighting the incidence and causes of CMS [ 3 ]. Collaborative articles between Gajjar, A. and Mabbott, D.J. in subsequent years focused on neurobehavioral outcomes and cognitive impairments associated with ppCMS, emphasizing the clinical aspect [ 12 , 45 – 47 ]. Kumar, R. and Pizer, B. through seven co-published papers, delved into the mechanisms and pathophysiology of ppCMS, elucidating aspects such as the bilateral involvement of the proximal efferent cerebellar pathway and perfusion deficits [ 13 , 38 , 43 , 48 – 51 ]. The review conducted in 2020 by Kumar, R. et al [ 52 ] underscored the importance of comprehensive rehabilitation plans for ppCMS. In conclusion, the evolving landscape of ppCMS research reflects a shift towards increased international collaboration, a surge in annual publications, and a focus on clinical and mechanistic aspects. High-impact journals and prolific authors contribute significantly to advancing our understanding of ppCMS. Schmahmann, J.D. (citation = 246), the most cited author, has significantly influenced the understanding of postoperative pediatric cerebellar mutism syndrome (ppCMS). In 2007, a pivotal paper in Cerebellum marked the initiation of attention to the cognitive and affective functions of the cerebellum [ 53 ]. Notably, Schmahmann, J.D., and colleagues published a highly impactful article in 2016, addressing the confusion in defining post-operative mutism [ 8 ]. They proposed a new definition for ppCMS, which has since become widely adopted in subsequent research. Three years later, Schmahmann, J.D. provided a comprehensive overview of cerebellum functions, distinguishing between sensorimotor and cognitive/limbic functions [ 54 ]. His recent work delves into the origins and evolution of concepts related to ppCMS, cerebellar cognitive affective syndrome (CCAS), and posterior fossa syndrome (PFS) [ 55 ]. Schmahmann, J.D.'s focus on clarifying foundational definitions and understanding cerebellum functions has laid a robust groundwork for future research in this field. 4.2 Knowledge Base To establish the research foundation for postoperative pediatric cerebellar mutism syndrome (ppCMS), we conducted a bibliometric analysis focusing on the 10 co-cited references with the highest co-citations. The seminal work by Pollack, I.F. in 1995, reporting the largest case series until 1999, provided detailed insights into 142 patients undergoing PFT resections, with 8.45% developing CMS. Clinical characteristics outlined the incidence, time course, and radiological features, suggesting bilateral injury to dentate nuclei pathways and edema as potential mechanisms for ppCMS [ 29 ]. This mechanism aligns with findings from the 3rd co-cited article in 1985 [ 2 ]. The 2nd and 5th co-cited papers identified brainstem invasion, medulloblastoma pathology, midline localization, and vermis incision as significant independent risk factors for ppCMS [ 3 , 31 ]. The 4th and 6th research in the journal of Brain explored higher-order cerebellar functions through ppCMS cases [ 30 , 32 ]. The 8th article highlighted oral-pharyngeal apraxia as a postoperative complication, emphasizing the relevance of surgical approaches, particularly vermis splitting [ 33 ]. The 9th article aimed to identify risk factors for ppCMS development [ 4 ], while the last co-cited paper elucidated the damage to the proximal dentatothalamocortical tract, crucial for understanding ppCMS anatomical substrates [ 34 ]. 4.3 Hotspots and Frontiers Drawing insights from the keyword clusters (Fig. 11 ) and the main research contents of references with strong citation bursts (Table 6 ), it becomes evident that the primary focus of ppCMS research pertains to the mechanisms, risk factors, and clinical manifestations (linguistic, cognitive, and affective disorders). While the clinical manifestations have been explicated in the Introduction, our primary emphasis lies in the exploration of mechanisms and risk factors. 4.3.1 Mechanisms of ppCMS 4.3.1.1 Anatomical substrates In 1995, Pollack, I.F. et al [ 29 ] pointed out that direct damage to the inferior vermian region cannot explain the low incidence and delayed onset of ppCMS. They observed that patients with ppCMS had a significantly increased incidence of bilateral edema of cerebellar peduncles, indicating there may exist a pathway traveling through this structure responsible for initiating speech and other voluntary movements. Most scholars reached the consensus that bilateral disruption to the DTC tract is the major cause of ppCMS [ 14 , 34 , 38 , 56 , 57 ]. Some of them are proven by diffusion magnetic resonance imaging (dMRI) [ 14 , 34 , 38 , 56 ]. After receiving afferent fibers from the lateral hemispheres and primary and supplementary motor area (SMA) of the cerebellum, The DTC pathway starts from the dentate nuclei and then ascends through the superior cerebellar peduncle and the brainstem, crosses over to the next order neurons contralateral ventrolateral nucleus of the thalamus (VL thalamus). Finally, this pathway terminates in the premotor, motor, prefrontal, and frontal cortices [ 34 , 58 ]. Theoretically, any damage to this tract may lead to ppCMS. However, few studies can answer the notion of the bilateral cerebellum's participation in motor-speech planning. In 2020, a tractography study published in Frontiers in Neuroanatomy found that the Crus-Broca tracts, which originated from the bilateral Crus lobe, synapsed in the dentate nucleus, ascended into the superior cerebellar peduncle, passed through the left red nucleus and the left thalamus, and terminated at the subregions of Broca’s complex. Conversely, the Broca-Crus tracts originated from the subregions of Broca’s complex, and the majority of efferent nerve fibers terminated at the right Crus lobes [ 59 ]. However, this finding needs further verification. Moreover, the proximal efferent cerebellar pathway is also a part of the dentato-rubro-olivary pathway (Guillain-Mollaret triangle), which is comprised of the contralateral dentate nucleus, the red nucleus, and the ipsilateral inferior olivary nucleus (ION) [ 13 ]. Disruption to any part of this triangle, especially the dentate nucleus, may cause hypertrophic olivary degeneration (HOD). Two research found that the presence of bilateral HOD was significantly associated with ppCMS occurrence [ 13 , 60 ], while the association between unilateral HOD and ppCMS appearance is not always significant [ 13 ]. For example, a paper published in 2021 did not find such a correlation between HOD and ppCMS [ 61 ]. When diagnosis of ppCMS is not sure, HOD can be used as a reliable radiological indicator [ 13 ]. Examining cognitive and affective disorders, the neuroscience of the cerebellum provides insights into the mechanisms underlying ppCMS. Human brain imaging reveals the involvement of the cognitive cerebellum in the posterior lobe and the limbic cerebellum, likely predominantly represented in the vermis, in distributed neural circuits crucial for cognition and emotion. Cognitive paradigms activate distinct regions within the cerebellar posterior lobe: (1) lobules VI and Crus I for language and verbal working memory; (2) lobule VI for spatial tasks; (3) lobules VI, Crus I, and VIIB for executive functions like working memory, planning, organization, and strategy formation; (4) Vermal lobules VI and VII for emotional processing. Language exhibits a strong right lateralization, and spatial functions show left lateralization, reflecting crossed cerebro-cerebellar projections [ 54 ]. In summary, elucidating pertinent neuro-conductive pathways and cerebellar functions is integral to a profound comprehension of the mechanisms underlying ppCMS. 4.3.1.2 Perfusion deficits There are findings utilizing single photon emission computed tomography (SPECT) [ 62 , 63 ], dynamic susceptibility contrast (DSC) [ 64 ], and arterial spin labeling (ASL) [ 65 – 67 ] to detect the cerebral perfusion alterations in children after PFT resection. The association between ppCMS and cerebral hypoperfusion was significant, involving the efferent pathway of the DTC tract, which was ascribed to the cerebella-cerebral diaschisis [ 65 , 66 ]. As bilateral frontal perfusion improved, the symptoms of ppCMS improved [ 63 , 66 ]. However, we still need to notice that not all the research confirms these findings and the characteristic of delayed onset needs further elucidation [ 68 ]. In a word, more and more articles support this mechanism to explain the characteristics of transient symptoms of ppCMS. 4.3.1.3 Edema Vasogenic edema is a possible cause of the delayed onset of ppCMS, which needs differentiation with cytotoxic edema through diffusion-weighted imaging (DWI) [ 49 ]. The edema may appear in the dentate nucleus, or the afferent or efferent pathways of DTC bilaterally [ 29 , 69 ]. However, edema cannot explain the phenomenon that the duration of ppCMS overlasts the remission of postoperative edema [ 69 ], suggesting other mechanisms exist. 4.3.2 Risk factors A 2022 systematic review and meta-analysis by Pettersson, S.D. et al [ 24 ] identified several risk factors for ppCMS, including brainstem invasion, fourth ventricle invasion, superior cerebellar peduncle invasion, diagnosis of medulloblastoma (MB), MB > 50 mm, vermis incision, and left-handedness. Protective factors included tumors located in the cerebellar hemisphere, cerebellar hemisphere compression, and intraoperative imaging. Splitting vermis has been proven as a significant risk factor of ppCMS occurrence [ 24 , 57 , 70 ], while whether the telovelar approach could decrease the morbidity of ppCMS remained unclear [ 71 ]. Current surgical guidelines for minimizing risk while preserving survival remain unclear. Radiation therapy is recognized as a prominent contributor to neurocognitive deficits, with the radiotherapy dose playing a pivotal role [ 72 ]. The impact of chemotherapy on cognitive development is contentious and likely contingent on its toxicity. For instance, Riva et al [ 73 ] observed a significant increase in cognitive difficulties among children administered methotrexate compared to other drugs. Subsequent research avenues could investigate: (1) surgical methodologies minimizing the risk of ppCMS; (2) conducting comparative analyses regarding the enduring effects of diverse radiotherapy techniques on long-term language, cognition, and emotional functions over the long term; (3) examining the impact of chemotherapy drugs on long-term language, cognition, and emotional functions. Notably, postoperative patients with posterior fossa tumors necessitate an evaluation of the surgical injury on the neuro-conductive pathway. Given the complexity of clinical manifestations, meticulous and comprehensive recording of ppCMS diagnosis and progression is paramount. 4.3.3 Rehabilitation Rehabilitation for ppCMS, requiring interdisciplinary collaboration and family involvement, is an underexplored area. Although specific interventions directly targeting ppCMS are lacking, studies on neurocognitive injuries in children with brain tumors provide potential references. Stimulant medications and neurotransmitter modulators, such as donepezil, may enhance attention and focus, while computer-based cognitive intervention programs show promise in improving working memory and addressing learning difficulties [ 74 – 78 ]. 4.4 Limitations Initially, the multitude of diverse and inconsistent definitions for ppCMS posed a challenge, and this heterogeneity in definitions persisted even after the Iceland Delphi results in 2016. This persistence can be attributed to variations in research subjects and etiologies, especially those studies excluding surgical aspects. Moreover, our reliance solely on data from the WoSCC database introduces a potential limitation, as it overlooks contributions from other databases, possibly resulting in the omission of relevant studies. Nonetheless, the Web of Science Core Collection (WoSCC) stands as the most widely utilized database in bibliometric analysis due to its comprehensive dataset, encompassing titles, authors, institutions, countries, abstracts, keywords, references, citation counts, impact factors, and other relevant information [ 79 ]. More importantly, due to the format constraints imposed by VOSviewer and CiteSpace, the amalgamation of multiple databases for analysis proved unfeasible. As of now, this technical challenge remains unresolved. Furthermore, the exclusion of non-English papers and publications from 2023 introduces the potential for publication bias, as noteworthy studies in other languages or recent publications may not be captured. 5. Conclusion The escalating number of publications underscores the growing global significance of ppCMS research. Leading the pack are the United States and England, with prominent institutions situated in North America and Europe. Despite this, fostering enhanced collaboration and communication across diverse countries and institutions is imperative. Child's Nervous System stands out as the most widely recognized journal, with numerous co-citations, predominantly originating from high-impact Q1 journals. Scholars predominantly concentrate on unraveling the mechanisms, risk factors, and clinical features of ppCMS. Areas requiring in-depth exploration include: (1) elucidating relevant neuro-conductive pathways and cerebellar functions; (2) developing surgical guidelines to minimize the risk of ppCMS; (3) conducting comparative analyses of the enduring effects of diverse radiotherapy techniques on long-term language, cognition, and emotional functions; (4) investigating the impact of chemotherapy drugs on sustained language, cognition, and emotional functions. Abbreviations AM: akinetic mutism ASL: arterial spin labeling CCAS: cerebellar cognitive affective syndrome CM: cerebellar mutism CMS: cerebellar mutism syndrome dMRI: diffusion magnetic resonance imaging DSC: dynamic susceptibility contrast DWI: diffusion-weighted imaging HOD: hypertrophic olivary degeneration ION: inferior olivary nucleus pCMS: postoperative cerebellar mutism syndrome PFS: posterior fossa syndrome PFT: posterior fossa tumor ppCMS: Post-operative pediatric cerebellar mutism syndrome MB: medulloblastoma MSD: subsequent dysarthria SMA: supplementary motor area SPECT: single photon emission computed tomography TCM: transient cerebellar mutism WoSCC: Web of Science Core Collection Declarations Ethics approval and consent to participate Not applicable. Consent for publication Not applicable. Availability of data and materials The datasets supporting the conclusions drawn in this article can be made accessible by contacting the corresponding authors through a reasonable request. Competing interests The authors declare that there are no conflicts of interest. Funding Not applicable. Author contributions Qingtian Liang was the lead author and designed the study. Yizhi Du and Zhuqing Cheng were responsible for the introduction, literature search, and data collection. Qingtian Liang and Zuqing Wu were responsible for the results, including data analysis and table/figure creation. Qingtian Liang, Zuqing Wu, and Sihan Zhu were responsible for the discussion. Sihan Zhu, Qingtian Liang, Yinsheng Chen, Xiangheng Zhang, Jian Wang, and Fuhua Lin were responsible for the article revision. All authors contributed to the article and approved the submitted version. Acknowledgments The authors would like to thank those individuals who made the VOSviewer, the R package “bibliometricx”, and CiteSpace open-source software available. References Daly DD, Love JG. Akinetic mutism. Neurology. 1958 Mar;8(3):238–42. Rekate HL, Grubb RL, Aram DM, Hahn JF, Ratcheson RA. Muteness of cerebellar origin. Arch Neurol. 1985 Jul;42(7):697–8. Robertson PL, Muraszko KM, Holmes EJ, Sposto R, Packer RJ, Gajjar A, et al. Incidence and severity of postoperative cerebellar mutism syndrome in children with medulloblastoma: a prospective study by the Children’s Oncology, Group. JOURNAL OF NEUROSURGERY. 2006 Dec;105(6):444–51. van Dongen HR, Catsman-Berrevoets CE, van Mourik M. The syndrome of “cerebellar” mutism and subsequent dysarthria. Neurology. 1994 Nov;44(11):2040–6. Van Calenbergh F, Van de Laar A, Plets C, Goffin J, Casaer P. Transient cerebellar mutism after posterior fossa surgery in children. Neurosurgery. 1995 Nov;37(5):894–8. Schmahmann JD, Sherman JC. Cerebellar cognitive affective syndrome. Int Rev Neurobiol. 1997;41:433–40. Schmahmann JD, Sherman JC. The cerebellar cognitive affective syndrome. Brain. 1998 Apr;121 ( Pt 4):561–79. Gudrunardottir T, Morgan AT, Lux AL, Walker DA, Walsh KS, Wells EM, et al. Consensus paper on post-operative pediatric cerebellar mutism syndrome: the Iceland Delphi results. CHILDS NERVOUS SYSTEM. 2016 Jul;32(7):1195–203. Toescu SM, Hales PW, Cooper J, Dyson EW, Mankad K, Clayden JD, et al. Arterial Spin-Labeling Perfusion Metrics in Pediatric Posterior Fossa Tumor Surgery. Am J Neuroradiol. 2022;43(10):1508–15. Jabarkheel R, Amayiri N, Yecies D, Huang Y, Toescu S, Nobre L, et al. Molecular correlates of cerebellar mutism syndrome in medulloblastoma. NEURO-ONCOLOGY. 2020 Feb;22(2):290–7. Spiteri M, Guillemaut JY, Windridge D, Avula S, Kumar R, Lewis E. Fully-Automated Identification of Imaging Biomarkers for Post-Operative Cerebellar Mutism Syndrome Using Longitudinal Paediatric MRI. NEUROINFORMATICS. 2020 Jan;18(1):151–62. Schreiber JE, Palmer SL, Conklin HM, Mabbott DJ, Swain MA, Bonner MJ, et al. Posterior fossa syndrome and long-term neuropsychological outcomes among children treated for medulloblastoma on a multi-institutional, prospective study. NEURO-ONCOLOGY. 2017 Dec;19(12):1673–82. Avula S, Spiteri M, Kumar R, Lewis E, Harave S, Windridge D, et al. Post-operative pediatric cerebellar mutism syndrome and its association with hypertrophic olivary degeneration. QUANTITATIVE IMAGING IN MEDICINE AND SURGERY. 2016 Oct;6(5):535–44. Perreault S, Lober RM, Cheshier S, Partap S, Edwards MS, Yeom KW. Time-dependent structural changes of the dentatothalamic pathway in children treated for posterior fossa tumor. Am J Neuroradiol. 2014;35(4):803–7. Lewison G, Devey ME. Bibliometric methods for the evaluation of arthritis research. Rheumatology (Oxford). 1999 Jan;38(1):13–20. Wu F, Gao J, Kang J, Wang X, Niu Q, Liu J, et al. Knowledge Mapping of Exosomes in Autoimmune Diseases: A Bibliometric Analysis (2002–2021). Front Immunol. 2022 Jul 22;13:939433. Ninkov A, Frank JR, Maggio LA. Bibliometrics: Methods for studying academic publishing. Perspect Med Educ. 2022 Jun;11(3):173–6. Arruda H, Silva ER, Lessa M, Proença D, Bartholo R. VOSviewer and Bibliometrix. J Med Libr Assoc. 2022 Jul 1;110(3):392–5. Chen C, Song M. Visualizing a field of research: A methodology of systematic scientometric reviews. PLOS ONE. 2019 Oct 31;14(10):e0223994. Ashida R, Nazar N, Edwards R, Teo M. Cerebellar Mutism Syndrome: An Overview of the Pathophysiology in Relation to the Cerebrocerebellar Anatomy, Risk Factors, Potential Treatments, and Outcomes. WORLD NEUROSURGERY. 2021 Sep;153:63–74. van Baarsen KM, Grotenhuis JA. The anatomical substrate of cerebellar mutism. MEDICAL HYPOTHESES. 2014 Jun;82(6):774–80. Gudrunardottir T, Sehested A, Juhler M, Schmiegelow K. Cerebellar mutism. CHILDS NERVOUS SYSTEM. 2011 Mar;27(3):355–63. Ozgur BM, Berberian J, Aryan HE, Meltzer HS, Levy ML. The pathophysiologic mechanism of cerebellar mutism. SURGICAL NEUROLOGY. 2006 Jul;66(1):18–25. Pettersson SD, Kitlinski M, Miekisiak G, Ali S, Krakowiak M, Szmuda T. Risk factors for postoperative cerebellar mutism syndrome in pediatric patients: a systematic review and meta-analysis. JOURNAL OF NEUROSURGERY-PEDIATRICS. 2022 Apr;29(4):467–75. van Eck NJ, Waltman L. Software survey: VOSviewer, a computer program for bibliometric mapping. Scientometrics. 2010 Aug;84(2):523–38. Zeng L, Ma G, Chen K, Zhou Q. Bibliometric analysis of rheumatic immune related adverse events associated with immune checkpoint inhibitors. Front Immunol. 2023;14:1242336. Synnestvedt MB, Chen C, Holmes JH. CiteSpace II: visualization and knowledge discovery in bibliographic databases. AMIA Annu Symp Proc. 2005;2005:724–8. Huang X, Fan X, Ying J, Chen S. Emerging trends and research foci in gastrointestinal microbiome. J Transl Med. 2019 Dec;17(1):67. Pollack IF, Polinko P, Albright AL, Towbin R, Fitz C. Mutism and pseudobulbar symptoms after resection of posterior fossa tumors in children: incidence and pathophysiology. Neurosurgery. 1995 Nov;37(5):885–93. Levisohn L, Cronin-Golomb A, Schmahmann JD. Neuropsychological consequences of cerebellar tumour resection in children - Cerebellar cognitive affective syndrome in a paediatric population. BRAIN. 2000 May;123:1041–50. Catsman-Berrevoets CE, Van Dongen HR, Mulder PG, Paz y Geuze D, Paquier PF, Lequin MH. Tumour type and size are high risk factors for the syndrome of “cerebellar” mutism and subsequent dysarthria. J Neurol Neurosurg Psychiatry. 1999 Dec;67(6):755–7. Riva D, Giorgi C. The cerebellum contributes to higher functions during development: evidence from a series of children surgically treated for posterior fossa tumours. Brain. 2000 May;123 ( Pt 5):1051–61. Dailey AT, McKhann GM, Berger MS. The pathophysiology of oral pharyngeal apraxia and mutism following posterior fossa tumor resection in children. J Neurosurg. 1995 Sep;83(3):467–75. Morris EB, Phillips NS, Laningham FH, Patay Z, Gajjar A, Wallace D, et al. Proximal dentatothalamocortical tract involvement in posterior fossa syndrome. BRAIN. 2009 Nov;132:3087–95. Law N, Greenberg M, Bouffet E, Taylor MD, Laughlin S, Strother D, et al. Clinical and neuroanatomical predictors of cerebellar mutism syndrome. NEURO-ONCOLOGY. 2012 Oct;14(10):1294–303. Wells EM, Khademian ZP, Walsh KS, Vezina G, Sposto R, Keating RF, et al. Postoperative cerebellar mutism syndrome following treatment of medulloblastoma: neuroradiographic features and origin Clinical article. JOURNAL OF NEUROSURGERY-PEDIATRICS. 2010 Apr;5(4):329–34. Wells EM, Walsh KS, Khademian ZP, Keating RF, Packer RJ. THE CEREBELLAR MUTISM SYNDROME AND ITS RELATION TO CEREBELLAR COGNITIVE FUNCTION AND THE CEREBELLAR COGNITIVE AFFECTIVE DISORDER. DEVELOPMENTAL DISABILITIES RESEARCH REVIEWS. 2008;14(3):221–8. Avula S, Kumar R, Pizer B, Pettorini B, Abernethy L, Garlick D, et al. Diffusion abnormalities on intraoperative magnetic resonance imaging as an early predictor for the risk of posterior fossa syndrome. Neuro-Oncology. 2015 Apr 1;17(4):614–22. De Smet HJ, Baillieux H, Catsman-Berrevoets C, De Deyn PP, Marien P, Paquier PF. Postoperative motor speech production in children with the syndrome of “cerebellar” mutism and subsequent dysarthria: A critical review of the literature. EUROPEAN JOURNAL OF PAEDIATRIC NEUROLOGY. 2007 Jul;11(4):193–207. Patay Z. Postoperative posterior fossa syndrome: unraveling the etiology and underlying pathophysiology by using magnetic resonance imaging. CHILDS NERVOUS SYSTEM. 2015 Oct;31(10):1853–8. Aarsen FK, Van Dongen HR, Paquier PF, Van Mourik M, Catsman-Berrevoets CE. Long-term sequelae in children after cerebellar astrocytoma surgery. Neurology. 2004 Apr 27;62(8):1311–6. Huber JF, Bradley K, Spiegler BJ, Dennis M. Long-term effects of transient cerebellar mutism after cerebellar astrocytoma or medulloblastoma tumor resection in childhood. CHILDS NERVOUS SYSTEM. 2006 Feb;22(2):132–8. Liu JF, Dineen RA, Avula S, Chambers T, Dutta M, Jaspan T, et al. Development of a pre-operative scoring system for predicting risk of post-operative paediatric cerebellar mutism syndrome. British Journal of Neurosurgery. 2018 Jan 2;32(1):18–27. Lanier JC, Abrams AN. Posterior Fossa Syndrome: Review of the Behavioral and Emotional Aspects in Pediatric Cancer Patients. CANCER. 2017 Feb 15;123(4):551–9. Palmer SL, Hassall T, Evankovich K, Mabbott DJ, Bonner M, Deluca C, et al. Neurocognitive outcome 12 months following cerebellar mutism syndrome in pediatric patients with medulloblastoma. NEURO-ONCOLOGY. 2010 Dec;12(12):1311–7. Knight SJ, Conklin HM, Palmer SL, Schreiber JE, Armstrong CL, Wallace D, et al. Working Memory Abilities Among Children Treated for Medulloblastoma: Parent Report and Child Performance. JOURNAL OF PEDIATRIC PSYCHOLOGY. 2014 Jun;39(5):501–11. Schreiber JE, Gurney JG, Palmer SL, Bass JK, Wang M, Chen S, et al. Examination of risk factors for intellectual and academic outcomes following treatment for pediatric medulloblastoma. NEURO-ONCOLOGY. 2014 Aug;16(8):1129–36. Zakaria R, Ellenbogen J, Graham C, Pizer B, Mallucci C, Kumar R. A decision analysis tool for the assessment of posterior fossa tumour surgery outcomes in children-the “Liverpool Neurosurgical Complication Causality Assessment Tool.” CHILDS NERVOUS SYSTEM. 2013 Aug;29(8):1277–83. Avula S, Mallucci C, Kumar R, Pizer B. Posterior fossa syndrome following brain tumour resection: review of pathophysiology and a new hypothesis on its pathogenesis. CHILDS NERVOUS SYSTEM. 2015 Oct;31(10):1859–67. Hartley H, Pizer B, Lane S, Sneade C, Williams R, Mallucci C, et al. Incidence and prognostic factors of ataxia in children with posterior fossa tumors. NEURO-ONCOLOGY PRACTICE. 2019 Jun;6(3):185–93. Deghedy M, Pizer B, Kumar R, Mallucci C, Avula S. Basilar Artery Vasospasm as a Cause of Post-Operative Cerebellar Mutism Syndrome. CASE REPORTS IN PEDIATRICS. 2022 Feb 10;2022:9148100. Paquier PF, Walsh KS, Docking KM, Hartley H, Kumar R, Catsman-Berrevoets CE. Post-operative cerebellar mutism syndrome: rehabilitation issues. CHILDS NERVOUS SYSTEM. 2020 Jun;36(6):1215–22. Schmahmann JD, Weilburg JB, Sherman JC. The neuropsychiatry of the cerebellum - insights from the clinic. CEREBELLUM. 2007;6(3):254–67. Schmahmann JD. The cerebellum and cognition. NEUROSCIENCE LETTERS. 2019 Jan 1;688:62–75. Schmahmann JD. Pediatric post-operative cerebellar mutism syndrome, cerebellar cognitive affective syndrome, and posterior fossa syndrome: historical review and proposed resolution to guide future study. CHILDS NERVOUS SYSTEM. 2020 Jun;36(6):1205–14. Toescu SM, Hales PW, Kaden E, Lacerda LM, Aquilina K, Clark CA. Tractographic and Microstructural Analysis of the Dentato-Rubro-Thalamo-Cortical Tracts in Children Using Diffusion MRI. CEREBRAL CORTEX. 2021 May;31(5):2595–609. Puget S, Boddaert N, Viguier D, Kieffer V, Bulteau C, Garnett M, et al. Injuries to Inferior Vermis and Dentate Nuclei Predict Poor Neurological and Neuropsychological Outcome in Children With Malignant Posterior Fossa Tumors. CANCER. 2009 Mar 15;115(6):1338–47. Gadgil N, Hansen D, Barry J, Chang R, Lam S. Posterior fossa syndrome in children following tumor resection: Knowledge update. Surg Neurol Int. 2016;7(Suppl 6):S179-183. Zhang H, Bao Y, Feng Y, Hu H, Wang Y. Evidence for Reciprocal Structural Network Interactions Between Bilateral Crus Lobes and Broca’s Complex. FRONTIERS IN NEUROANATOMY. 2020 Jun 18;14:27. Beez T, Munoz-Bendix C, Mijderwijk HJ, Remke M, Haenggi D. Structural damage burden and hypertrophic olivary degeneration in pediatric postoperative cerebellar mutism syndrome. NEUROSURGICAL REVIEW. 2022 Aug;45(4):2757–65. Schaller-Paule MA, Baumgarten P, Seifert V, Wagner M, Steidl E, Hattingen E, et al. A Paravermal Trans-Cerebellar Approach to the Posterior Fossa Tumor Causes Hypertrophic Olivary Degeneration by Dentate Nucleus Injury. Cancers (Basel). 2021 Jan 12;13(2):258. Catsman-Berrevoets CE, Aarsen FK. The spectrum of neurobehavioural deficits in the Posterior Fossa Syndrome in children after cerebellar tumour surgery. CORTEX. 2010 Aug;46(7):933–46. De Smet HJ, Baillieux H, Wackenier P, De Praeter M, Engelborghs S, Paquier PF, et al. Long-Term Cognitive Deficits Following Posterior Fossa Tumor Resection: A Neuropsychological and Functional Neuroimaging Follow-Up Study. NEUROPSYCHOLOGY. 2009 Nov;23(6):694–704. Miller NG, Reddick WE, Kocak M, Glass JO, Loebel U, Morris B, et al. Cerebellocerebral Diaschisis Is the Likely Mechanism of Postsurgical Posterior Fossa Syndrome in Pediatric Patients with Midline Cerebellar Tumors. AMERICAN JOURNAL OF NEURORADIOLOGY. 2010 Feb;31(2):288–94. Boisgontier J, Fillon L, Rutten C, Saitovitch A, Dufour C, Lemaitre H, et al. A CBF decrease in the left supplementary motor areas: New insight into postoperative pediatric cerebellar mutism syndrome using arterial spin labeling perfusion MRI. JOURNAL OF CEREBRAL BLOOD FLOW AND METABOLISM. 2021 Dec;41(12):3339–49. Yecies D, Shpanskaya K, Jabarkheel R, Maleki M, Bruckert L, Cheshier SH, et al. Arterial spin labeling perfusion changes of the frontal lobes in children with posterior fossa syndrome. JOURNAL OF NEUROSURGERY-PEDIATRICS. 2019 Oct;24(4):382–8. Watanabe Y, Yamasaki F, Nakamura K, Kajiwara Y, Takayasu T, Nosaka R, et al. Evaluation of cerebellar mutism by arterial spin-labeling perfusion magnetic resonance imaging in a patient with atypical teratoid/rhabdoid tumor (AT/RT): a case report. CHILDS NERVOUS SYSTEM. 2012 Aug;28(8):1257–60. Ersahin Y, Yararbas Ü, Duman Y, Mutluer S. Single photon emission tomography following posterior fossa surgery in patients with and without mutism. CHILDS NERVOUS SYSTEM. 2002 Jul;18(6–7):318–25. Siffert J, Poussaint TY, Goumnerova LC, Scott RM, LaValley B, Tarbell NJ, et al. Neurological dysfunction associated with postoperative cerebellar mutism. JOURNAL OF NEURO-ONCOLOGY. 2000 May;48(1):75–81. Grill J, Viguier D, Kieffer V, Bulteau C, Sainte-Rose C, Hartmann O, et al. Critical risk factors for intellectual impairment in children with posterior fossa tumors: the role of cerebellar damage. JOURNAL OF NEUROSURGERY. 2004 Nov;101(2):152–8. Tamburrini G, Frassanito P, Chieffo D, Massimi L, Caldarelli M, Di Rocco C. Cerebellar mutism. Childs Nerv Syst. 2015 Oct;31(10):1841–51. de Speville ED, Kieffer V, Dufour C, Grill J, Noulhiane M, Hertz-Pannier L, et al. Neuropsychological consequences of childhood medulloblastoma and possible interventions: A review. NEUROCHIRURGIE. 2021 Feb;67(1):90–8. Riva D, Giorgi C, Nichelli F, Bulgheroni S, Massimino M, Cefalo G, et al. Intrathecal methotrexate affects cognitive function in children with medulloblastoma. Neurology. 2002 Jul 9;59(1):48–53. Mulhern RK, Khan RB, Kaplan S, Helton S, Christensen R, Bonner M, et al. Short-term efficacy of methylphenidate: a randomized, double-blind, placebo-controlled trial among survivors of childhood cancer. J Clin Oncol. 2004 Dec 1;22(23):4795–803. Thompson SJ, Leigh L, Christensen R, Xiong X, Kun LE, Heideman RL, et al. Immediate neurocognitive effects of methylphenidate on learning-impaired survivors of childhood cancer. J Clin Oncol. 2001 Mar 15;19(6):1802–8. Castellino SM, Tooze JA, Flowers L, Hill DF, McMullen KP, Shaw EG, et al. Toxicity and efficacy of the acetylcholinesterase (AChe) inhibitor donepezil in childhood brain tumor survivors: a pilot study. Pediatr Blood Cancer. 2012 Sep;59(3):540–7. Cox LE, Ashford JM, Clark KN, Martin-Elbahesh K, Hardy KK, Merchant TE, et al. Feasibility and acceptability of a remotely administered computerized intervention to address cognitive late effects among childhood cancer survivors. Neurooncol Pract. 2015 Jun;2(2):78–87. Hardy KK, Willard VW, Allen TM, Bonner MJ. Working memory training in survivors of pediatric cancer: a randomized pilot study. Psychooncology. 2013 Aug;22(8):1856–65. Ding X, Yang Z. Knowledge mapping of platform research: a visual analysis using VOSviewer and CiteSpace. Electron Commer Res. 2022 Sep;22(3):787–809. Additional Declarations No competing interests reported. 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07:23:32","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4443326/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4443326/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":57942980,"identity":"f51375b7-6dec-4fc4-8647-46d947d68566","added_by":"auto","created_at":"2024-06-07 19:02:37","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":460316,"visible":true,"origin":"","legend":"\u003cp\u003ePublication screening flowchart.\u003c/p\u003e","description":"","filename":"FIGURE1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4443326/v1/5f247b3293b930262268637c.jpg"},{"id":57942969,"identity":"c0e77d99-d966-403a-9ae5-3e48a9eac934","added_by":"auto","created_at":"2024-06-07 19:02:25","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":406008,"visible":true,"origin":"","legend":"\u003cp\u003eAnnual output of research in postoperative pediatric cerebellar mutism syndrome.\u003c/p\u003e","description":"","filename":"FIGURE2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4443326/v1/0debaaf07c46d980bba13e0e.jpg"},{"id":57943063,"identity":"05cd9f4c-4d91-42b8-997d-ecb492084523","added_by":"auto","created_at":"2024-06-07 19:02:42","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":190031,"visible":true,"origin":"","legend":"\u003cp\u003eThe geographic distribution (A) and visualization of countries (B) on the research of postoperative pediatric cerebellar mutism syndrome.\u003c/p\u003e","description":"","filename":"3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4443326/v1/38ab6112fec1d343483c7546.jpg"},{"id":57942971,"identity":"d2500ec9-2943-4d91-a0fe-5f08d2dd4ab1","added_by":"auto","created_at":"2024-06-07 19:02:25","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":578575,"visible":true,"origin":"","legend":"\u003cp\u003eThe visualization of institutions on the research of postoperative pediatric cerebellar mutism syndrome.\u003c/p\u003e","description":"","filename":"FIGURE4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4443326/v1/3c24028243a356d44cdedf36.jpg"},{"id":57943069,"identity":"f687a315-1ad7-4340-aee8-b5f855d6339a","added_by":"auto","created_at":"2024-06-07 19:02:43","extension":"jpg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":748771,"visible":true,"origin":"","legend":"\u003cp\u003eThe visualization of journals (A) and co-cited journals (B) on the research of postoperative pediatric cerebellar mutism syndrome.\u003c/p\u003e","description":"","filename":"5.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4443326/v1/ec47fd05acd2ae77743b844d.jpg"},{"id":57943065,"identity":"d149e030-52ad-4083-8329-759deef395e5","added_by":"auto","created_at":"2024-06-07 19:02:43","extension":"jpg","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":3726227,"visible":true,"origin":"","legend":"\u003cp\u003eThe dual-map overlay of journals on research of postoperative pediatric cerebellar mutism syndrome.\u003c/p\u003e","description":"","filename":"FIGURE6.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4443326/v1/057e8cfbc59f5561ec22abdd.jpg"},{"id":57943067,"identity":"c4671247-a40c-4c75-b69c-3363dd903f3b","added_by":"auto","created_at":"2024-06-07 19:02:43","extension":"jpg","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":537928,"visible":true,"origin":"","legend":"\u003cp\u003eThree-field plot of author country (left), journal (middle), and affiliation (right).\u003c/p\u003e","description":"","filename":"FIGURE7.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4443326/v1/9a94d77e35e11d34c629eac6.jpg"},{"id":57943062,"identity":"08b80dec-a8bb-4cd7-a2b3-b903f287792f","added_by":"auto","created_at":"2024-06-07 19:02:42","extension":"jpg","order_by":8,"title":"Figure 8","display":"","copyAsset":false,"role":"figure","size":523209,"visible":true,"origin":"","legend":"\u003cp\u003eThe visualization of authors (A) and co-cited Authors (B) on the research of postoperative pediatric cerebellar mutism syndrome.\u003c/p\u003e","description":"","filename":"8.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4443326/v1/a3662e4b1da94ec50e3482f3.jpg"},{"id":57942979,"identity":"da4e291e-870e-48d7-be56-42114a602451","added_by":"auto","created_at":"2024-06-07 19:02:36","extension":"jpg","order_by":9,"title":"Figure 9","display":"","copyAsset":false,"role":"figure","size":1329220,"visible":true,"origin":"","legend":"\u003cp\u003eThe visualization of co-cited references on the research of postoperative pediatric cerebellar mutism syndrome.\u003c/p\u003e","description":"","filename":"FIGURE9.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4443326/v1/e6d5bd884d2f7f9c5dd09334.jpg"},{"id":57943060,"identity":"742d29e1-8c3b-47b6-b94c-42d75b2e2a4a","added_by":"auto","created_at":"2024-06-07 19:02:41","extension":"jpg","order_by":10,"title":"Figure 10","display":"","copyAsset":false,"role":"figure","size":1072155,"visible":true,"origin":"","legend":"\u003cp\u003eTop 15 references with strong citation bursts. The red bars indicate high citations in certain years.\u003c/p\u003e","description":"","filename":"FIGURE10.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4443326/v1/baba7df711570f085c6632ef.jpg"},{"id":57942978,"identity":"40ddaa2b-82df-41c0-8fdd-263df2a561ad","added_by":"auto","created_at":"2024-06-07 19:02:34","extension":"jpg","order_by":11,"title":"Figure 11","display":"","copyAsset":false,"role":"figure","size":1085527,"visible":true,"origin":"","legend":"\u003cp\u003eKeyword cluster analysis (A) and trend topic analysis (B).\u003c/p\u003e","description":"","filename":"FIGURE11.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4443326/v1/a2da1a653f68383acaa22725.jpg"},{"id":57944647,"identity":"47195994-70d3-4d82-ab60-8aed348b7bf6","added_by":"auto","created_at":"2024-06-07 19:10:52","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":11542525,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4443326/v1/1367c57f-7ca3-4f41-9cdf-abcf0aef29df.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Research Trends of Post-operative Pediatric Cerebellar Mutism Syndrome: A Bibliometric Analysis (1999-2022)","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eIn early 1958, Daly, D.D., and Love, J.G. coined the term akinetic mutism (AM) to describe the absence of speech following posterior fossa tumor (PFT) surgery [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Over the ensuing six decades, various terms such as cerebellar mutism (CM), cerebellar mutism syndrome (CMS), cerebellar mutism and subsequent dysarthria (MSD), posterior fossa syndrome (PFS), transient cerebellar mutism (TCM), and cerebellar cognitive affective syndrome (CCAS) have been employed in different studies [\u003cspan additionalcitationids=\"CR3 CR4 CR5 CR6\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. To address the confusion surrounding the postoperative cerebellar mutism syndrome (pCMS), Gudrunardottir, T. et al [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] proposed a new definition under the \"modified Delphi\" methodology: \"Post-operative pediatric CMS is characterized by delayed onset mutism/reduced speech and emotional lability after cerebellar or 4th ventricle tumor surgery in children. Additional common features include hypotonia and oropharyngeal dysfunction/dysphagia. It may frequently be accompanied by cerebellar motor syndrome, cerebellar cognitive affective syndrome, brain stem dysfunction including long tract signs, and cranial neuropathies. The mutism is always transient, but recovery from CMS may be prolonged. Speech and language may not return to normal, and other deficits of cognitive, affective, and motor function often persist\". The reported incidence of ppCMS ranges from 17.5\u0026ndash;32.1% [\u003cspan additionalcitationids=\"CR10 CR11 CR12 CR13\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eLewison, G. astutely likened bibliometrics to scientific papers in the same way epidemiology is to patients [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. On one hand, bibliometrics offers both quantitative and qualitative insights into the interconnections among various elements such as countries, institutions, journals, authors, papers, keywords, and more [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. On the other hand, it serves as a valuable tool for discerning the evolutionary trends within a specific field [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Popular bibliometric tools for domain visualization include VOSviewer, the R package \"bibliometrix,\" and Citespace [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eNumerous authors have delved into the exploration of postoperative pediatric cerebellar mutism syndrome (ppCMS), scrutinizing its anatomical substrates, pathophysiology, risk factors, and potential treatments [\u003cspan additionalcitationids=\"CR21 CR22 CR23\" citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. However, the conventional categorization and synthesis of literature are profoundly dependent on the subjective judgments of authors, thereby presenting formidable challenges in conducting comprehensive and precise analyses of a substantial volume of literature, as well as in replicating such evaluations. In addition, it is hard to know the trends in a certain field when times change. Furthermore, a comprehensive investigation into various factors such as countries, institutions, journals, authors, references, citation bursts, and keywords has not been conducted on ppCMS to date [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. To address this gap, we employ bibliometric methodology to quantify and visualize published papers in this domain from 1999 to 2022. The primary objective is to unveil research trends and hotspots in ppCMS, facilitating researchers in pursuing further in-depth studies.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Search Strategy\u003c/h2\u003e \u003cp\u003eIn order to search the relevant literature extensively, we conducted a literature search (used by Pettersson, S.D. et al [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] in a systematic review and a meta-analysis) on the Web of Science Core Collection (WoSCC) database (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.webofscience.com/wos/woscc/basic-search\u003c/span\u003e\u003cspan address=\"https://www.webofscience.com/wos/woscc/basic-search\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e) on 14 October 2023. The search strategy is TS = ((posterior fossa syndrome OR mutism OR dysarthria) AND (tumor* OR medulloblastoma* OR ependymoma* OR astrocytoma*) AND (pediatric* OR child* OR teenager* OR adolescent*)) AND LA = (English), and only \u0026ldquo;articles\u0026rdquo; and \u0026ldquo;reviews\u0026rdquo; were included (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Data Analysis\u003c/h2\u003e \u003cp\u003eWe employed powerful bibliometric tools to comprehensively analyze postoperative pediatric cerebellar mutism syndrome (ppCMS) publications.\u003c/p\u003e \u003cp\u003eVOSviewer (version 1.6.19) is a powerful software tool for exploring the relationships between various aspects of research publications based on network data in three representations: network, overlay, or density visualization [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. In our study, VOSviewer was mainly used to visualize the analysis of country and institution, journal and co-cited journal, author and co-cited author, co-cited references, and keyword co-occurrence through network and overlay visualization. Within the network visualization map, individual nodes correspond to distinct parameters, including countries/regions, institutions, journals, authors, or keywords. The node size is indicative of its strength, encompassing factors such as the number of publications, citations, and occurrences. Concurrently, the thickness of the links denotes the strength of network associations. Color-coded nodes and links are employed to denote clusters and connections, respectively, with clusters sharing the same color automatically designated to closely related terms [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eBibliometrix (version 4.1.3) (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.bibliometrix.org\u003c/span\u003e\u003cspan address=\"https://www.bibliometrix.org\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e) is a package that needs to be utilized in the R programming environment [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. After data import and conversion to R format, it was applied to construct a global distribution network of publications of ppCMS and to create a three-field plot that reflects the associations among author country, journals, and affiliations.\u003c/p\u003e \u003cp\u003eCiteSpace (version 6.1.R6) emerged as another valuable tool for bibliometric and content analytic visualizations [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Our utilization of CiteSpace included mapping the dual-map overlay of journals and identifying references with citation bursts. If a paper suddenly shows a sharp increase in citations, namely citation bursts, an appropriate explanation is that the paper has hit on an important part of the field over a period of time [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn tandem, Microsoft Office Excel 2021 was employed to analyze the trend of annual publication numbers. This integrated approach allowed for a comprehensive and insightful exploration of the ppCMS research landscape.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Quantitative Analysis of Publication\u003c/h2\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eUtilizing our search formula, we identified a total of 410 studies on postoperative pediatric cerebellar mutism syndrome (ppCMS) from 1999 to 2022, comprising 334 \"articles\" and 76 \"reviews.\" Analyzing the annual growth rate of publications, we categorized the entire timeframe into three periods: Period I (1999\u0026ndash;2005), Period II (2006\u0026ndash;2019), and Period III (2020\u0026ndash;2022).\u003c/p\u003e \u003cp\u003eAs depicted in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, the average annual publication number during Phase I is 8.29. Except for 2001, each year in Phase I yielded fewer than 10 publications. In Phase II, the number of publications fluctuates between 14 and 23, with an average annual count of 17.86, notably higher than that of Phase I. In 2020, the publication number surged to 32, marking the first instance of surpassing 30 papers annually. Phase III exhibits an average annual publication number of 34.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Country and Institutional Analysis\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eTop 10 countries and institutions on the research of postoperative pediatric cerebellar mutism syndrome.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRank\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCountry\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCounts\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eInstituition\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCounts\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUSA (North America)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e141(34.39%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHospital for Sick Children (Canada)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e20(4.88%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEngland (Europe)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e38(9.27%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSt. Jude Children\u0026rsquo;s Research Hospital (USA)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e18(4.39%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCanada (North America)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34(8.29%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eUniversity of Toronto (Canada)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e15(3.66%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGermany (Europe)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34(8.29%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTexas Children\u0026rsquo;s hospital (USA)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e13(3.17%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eItaly (Europe)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e33(8.05%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eChildren\u0026rsquo;s National Hospital (USA)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e11(2.68%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAustralia (Oceania)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25(6.10%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAlder Hey Children\u0026rsquo;s NHS Foundation Trust (England)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e10(2.44%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNetherlands (Europe)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22(5.37%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMassachusetts General Hospital (USA)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e10(2.44%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrance (Europe)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18(4.39%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRoyal Children\u0026rsquo;s Hospital (Australia)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e9(2.20%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBelgium (Europe)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14(3.41%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eStanford University (USA)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e9(2.20%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIndia (Asia)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14(3.41%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eUniversity of Antwerp (Belgium)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e9(2.20%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eA total of 52 nations and 653 institutions actively contributed to the pool of publications on postoperative pediatric cerebellar mutism syndrome (ppCMS). Among the top 10 countries, Europe (n\u0026thinsp;=\u0026thinsp;6) and North America (n\u0026thinsp;=\u0026thinsp;2) predominate, with representation extending across Europe, North America, Asia, and Australia (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The United States leads with the highest number of publications (n\u0026thinsp;=\u0026thinsp;141, 34.39%), followed by Germany (n\u0026thinsp;=\u0026thinsp;34, 8.29%), Canada (n\u0026thinsp;=\u0026thinsp;34, 8.29%), and England (n\u0026thinsp;=\u0026thinsp;38, 9.27%). Notably, the combined publications from these four countries surpass half of the total (n\u0026thinsp;=\u0026thinsp;247, 60.24%). To visualize international collaboration, we constructed a collaborative network involving 37 countries with publication numbers equal to or greater than 2. The network, based on publication quantity and correlation, revealed robust international cooperation. For instance, the United States exhibited close collaboration with Europe, Canada, Australia, and China, reflecting a dynamic landscape of active international partnerships (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe Top 10 institutions are located in 5 countries, with three of them located in Europe and two located in North America. Each of the top 5 institutions published more than 10 papers. Then, we derived a collaborative network based on the quantity and correlation of publications of each institution, selecting 31 institutions for visualization based on the minimum number of publications equal to 5 (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). As depicted in Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, the cooperation between Hospital for Sick Children (Canada), University of Toronto (Canada), and Texas Children\u0026rsquo;s Hospital (USA) is very close. What\u0026rsquo;s more, there is active cooperation between St. Jude Children\u0026rsquo;s Research Hospital (USA), Hospital for Sick Children (Canada), and Texas Children\u0026rsquo;s Hospital (USA).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Journals and Co-cited Journals\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eTop 10 journals and Top 10 co-cited journals for research of postoperative pediatric cerebellar mutism syndrome.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRank\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJournal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCount\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIF\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eQ\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCo-cited Journal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eCo-citation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eIF\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eQ\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChild's Nervous System\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e67(16.34%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eQ3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eChild's Nervous System\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1162\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eQ3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePediatric Neurosurgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16(3.90%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eQ4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eJournal of Neurosurgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e852\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eQ1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePediatric Neurology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16(3.90%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eQ1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNeurosurgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e649\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eQ1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJournal of Neurosurgery-pediatrics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14(3.41%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eQ3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eJournal of Clinical Oncology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e575\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e45.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eQ1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNeuro-oncology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11(2.68%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eQ1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eBrain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e531\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e14.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eQ1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePediatric Blood \u0026amp; Cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11(2.68%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eQ2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ePediatric Neurosurgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e491\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eQ4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCerebellum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10(2.44%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eQ2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNeuro-oncology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e324\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e15.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eQ1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJournal of Neuro-oncology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9(2.20%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eQ2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNeurology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e324\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e9.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eQ1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWorld Neurosurgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8(1.95%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eQ3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eInternational Journal of Radiation Oncology Biology Physics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e279\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eQ1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJournal of Neurosurgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7(1.71%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eQ1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eJournal of Neuro-oncology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e267\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eQ2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003ePublications related to ppCMS were published in 161 journals. \u003cem\u003eChild\u0026rsquo;s Nervous System\u003c/em\u003e published most papers (n\u0026thinsp;=\u0026thinsp;67, 16.34%), followed by \u003cem\u003ePediatric Neurosurgery\u003c/em\u003e (n\u0026thinsp;=\u0026thinsp;16, 3.90%), and \u003cem\u003ePediatric Neurology\u003c/em\u003e (n\u0026thinsp;=\u0026thinsp;16, 3.90%). Among the top 10 journals, \u003cem\u003eNeuro-oncology\u003c/em\u003e (IF\u0026thinsp;=\u0026thinsp;15.9) has the greatest impact factor among the top 10 journals, followed by \u003cem\u003eJournal of Neurosurgery\u003c/em\u003e (IF\u0026thinsp;=\u0026thinsp;4.1). After that, we mapped the journal network and filtered 33 journals using the criterion that the minimum number of pertinent publications should be equal to 3. (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003eA). As can be seen in Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003eA, \u003cem\u003eChild\u0026rsquo;s Nervous System\u003c/em\u003e has active citation relationships with \u003cem\u003eWorld Neurosurgery\u003c/em\u003e, \u003cem\u003eJournal of Neurosurgery\u003c/em\u003e, \u003cem\u003ePediatric Neurology\u003c/em\u003e, \u003cem\u003ePediatric Neurosurgery\u003c/em\u003e, \u003cem\u003eJournal of Neuro-oncology\u003c/em\u003e, and \u003cem\u003ePediatric Blood \u0026amp; Cancer\u003c/em\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eAs shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, among the top 10 co-cited journals, \u003cem\u003eChild\u0026rsquo;s Nervous System\u003c/em\u003e was the most cited journal (Co-citation\u0026thinsp;=\u0026thinsp;1162), followed by \u003cem\u003eJournal of Neurosurgery\u003c/em\u003e (Co-citation\u0026thinsp;=\u0026thinsp;852), \u003cem\u003eNeurosurgery\u003c/em\u003e (Co-citation\u0026thinsp;=\u0026thinsp;649), \u003cem\u003eJournal of Clinical Oncology\u003c/em\u003e (Co-citation\u0026thinsp;=\u0026thinsp;575), and \u003cem\u003eBrain\u003c/em\u003e (Co-citation\u0026thinsp;=\u0026thinsp;531). Furthermore, the impact factor of the \u003cem\u003eJournal of Clinical Oncology\u003c/em\u003e is the highest (IF\u0026thinsp;=\u0026thinsp;45.3), followed by \u003cem\u003eNeuro-oncology\u003c/em\u003e (IF\u0026thinsp;=\u0026thinsp;15.9). To map the co-citation network, journals with a minimum co-citation of 100 were filtered out (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003eB). As illustrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003eB, \u003cem\u003eChild's Nervous System\u003c/em\u003e shows positive co-citation connections with both \u003cem\u003eNeurosurgery\u003c/em\u003e and \u003cem\u003ethe Journal of Neurosurgery.\u003c/em\u003e\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe dual-map overlay of journals displays clusters of citing journals on the left and clusters of cited journals on the right, illustrating the citation links between journals and co-cited journals [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. As depicted in Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e, the pink paths are the main citation paths, which represent the research published in Molecular, Biology, Genetics (pink path 1), Health, Nursing, Medicine (pink path 2), and Psychology, Education, Social (pink path 3) are mainly cited by literature in Neurology, Sports, and Ophthalmology. The research published in Psychology, Education, and Social (the green path) is also cited by the literature in Medicine, Medical, and Clinical.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eWe also created a three-field plot (San-key diagram) of country, journal, and affiliation. As shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig7\" class=\"InternalRef\"\u003e7\u003c/span\u003e, the publications from the United States are mainly published in \u003cem\u003eChild\u0026rsquo;s Nervous System\u003c/em\u003e, \u003cem\u003eNeuro-oncology\u003c/em\u003e, \u003cem\u003eJournal of Neurosurgery-pediatrics\u003c/em\u003e, and \u003cem\u003ePediatric Neurology\u003c/em\u003e. On the other hand, the top 4 affiliations are mostly published papers in \u003cem\u003eChild\u0026rsquo;s Nervous System\u003c/em\u003e and \u003cem\u003eNeuro-Oncology\u003c/em\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e3.4 Authors and Co-Cited Authors\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eTop 10 authors and co-cited authors on the research of postoperative pediatric cerebellar mutism syndrome.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRank\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eauthors\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ecount\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCo-Cited Authors\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ecitations\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGajjar, A.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSchmahmann, J.D.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e246\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMabbott, D.J.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePollack, I.F.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e210\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eKumar, R.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCatsman-berrevoets, C.E.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e151\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePizer, B.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eErsahin, Y.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e135\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAvula, S.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGudrunardottir, T.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e133\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBouffet, E.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRobertson, PL.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e131\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eConclin, H.M.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRiva, D.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e125\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJuhler, M.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDe Smet, H.J.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e97\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarien, P.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eWells, E.M.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e94\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePacker, R.J.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMulhern R.K.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e93\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eIn all, 2091 authors took part in the research of ppCMS. Among the top 10 authors, two authors published more than or equal to 10 papers (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). We constructed a collaborative network based on authors with more than or equal to four published papers (Fig.\u0026nbsp;\u003cspan refid=\"Fig7\" class=\"InternalRef\"\u003e7\u003c/span\u003eA). Gajjar, A. had the largest node because he published the most related publications. Furthermore, we noticed that several writers worked closely together. Gajjar, A., for instance, worked closely with Palmer, S.L.; Marien, P. actively collaborated with De Deyn, P.P.; and Pizer, B. actively worked with Kumar, R.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eSeven authors were co-cited more than 100 times out of the 6974 co-cited authors. Schmahmann, J.D. (n\u0026thinsp;=\u0026thinsp;246) is the most co-cited author, followed by Pollack, I.F. (n\u0026thinsp;=\u0026thinsp;120), and Catsman-berrevoets, C.E. (n\u0026thinsp;=\u0026thinsp;151). To map co-citation network graphs, authors with at least 50 co-citations were filtered (Fig.\u0026nbsp;\u003cspan refid=\"Fig8\" class=\"InternalRef\"\u003e8\u003c/span\u003eB). As illustrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig8\" class=\"InternalRef\"\u003e8\u003c/span\u003eB, there are ongoing partnerships between many co-cited writers. Schmahmann, J.D., for instance, collaborated closely with Pollack, I.F., Stoodley, C.J., and Riva, D.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e3.5 Co-Cited References\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eTop 10 co-cited references on the research of postoperative pediatric cerebellar mutism syndrome.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRank\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCo-cited reference\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCitations\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003epollack if, 1995, \u003cem\u003eneurosurgery\u003c/em\u003e, v37, p885, doi \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1227/00006123-199511000-00006\u003c/span\u003e\u003cspan address=\"10.1227/00006123-199511000-00006\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e126\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003erobertson pl, 2006, \u003cem\u003ej neurosurg\u003c/em\u003e, v105, p444, doi \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3171/ped.2006.105.6.444\u003c/span\u003e\u003cspan address=\"10.3171/ped.2006.105.6.444\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e125\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003erekate hl, 1985, \u003cem\u003earch neurol-chicago\u003c/em\u003e, v42, p697, doi \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1001/archneur.1985.04060070091023\u003c/span\u003e\u003cspan address=\"10.1001/archneur.1985.04060070091023\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e79\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003elevisohn l, 2000, \u003cem\u003ebrain\u003c/em\u003e, v123, p1041, doi \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1093/brain/123.5.1041\u003c/span\u003e\u003cspan address=\"10.1093/brain/123.5.1041\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e79\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ecatsman-berrevoets ce, 1999, \u003cem\u003ej neurol neurosur ps\u003c/em\u003e, v67, p755, doi \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1136/jnnp.67.6.755\u003c/span\u003e\u003cspan address=\"10.1136/jnnp.67.6.755\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e77\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eriva d, 2000, \u003cem\u003ebrain\u003c/em\u003e, v123, p1051, doi \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1093/brain/123.5.1051\u003c/span\u003e\u003cspan address=\"10.1093/brain/123.5.1051\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e77\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eschmahmann jd, 1998, brain, v121, p561, doi \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1093/brain/121.4.561\u003c/span\u003e\u003cspan address=\"10.1093/brain/121.4.561\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003edailey at, 1995, \u003cem\u003ej neurosurg\u003c/em\u003e, v83, p467, doi \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3171/jns.1995.83.3.0467\u003c/span\u003e\u003cspan address=\"10.3171/jns.1995.83.3.0467\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e68\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003evandongen hr, 1994, \u003cem\u003eneurology\u003c/em\u003e, v44, p2040, doi \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1212/wnl.44.11.2040\u003c/span\u003e\u003cspan address=\"10.1212/wnl.44.11.2040\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e65\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003emorris eb, 2009, \u003cem\u003ebrain\u003c/em\u003e, v132, p3087, doi \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1093/brain/awp241\u003c/span\u003e\u003cspan address=\"10.1093/brain/awp241\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e63\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThere are 9348 co-cited references on the research of ppCMS from 1999 to 2022. Two references were co-cited more than 100 times, and all of the top 10 co-cited references were co-cited at least 63 times (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). For the purpose of creating the co-citation network map (Fig.\u0026nbsp;\u003cspan refid=\"Fig9\" class=\"InternalRef\"\u003e9\u003c/span\u003e), we chose references with at least 30 co-citations. According to Fig.\u0026nbsp;\u003cspan refid=\"Fig9\" class=\"InternalRef\"\u003e9\u003c/span\u003e, \u0026ldquo;Pollack, I.F., 1995, neurosurgery\u0026rdquo; shows active co-cited relationships with \u0026ldquo;Robertson, P.L., 2006, \u003cem\u003eJ Neurosurg\u003c/em\u003e\u0026rdquo;, \u0026ldquo;Rekate, H.L., 1985, \u003cem\u003eArch Neurol-Chicago\u003c/em\u003e\u0026rdquo;, and \u0026ldquo;Catsman-berrevoets, C.E., 1999, \u003cem\u003eJ Neurol Neurosur Ps\u003c/em\u003e\u0026rdquo;.\u003c/p\u003e \u003cp\u003e \u003cb\u003e3.6 Reference with Citation Bursts\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe main research content of the 15 references with strong citation bursts.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRank\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStrength\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMain research content\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eForm a new definition of post-operative pediatric cerebellar mutism syndrome [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eApply a CMS questionnaire into two clinical trials to prospectively detect incidence, severity, and possible causes of cerebellar mutism occurrence [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eA prospective study to investigate presurgical and clinical factors associated with cerebellar mutism syndrome occurrence [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e].\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eA retrospective study to detect neuroradiographic features of cerebellar mutism syndrome, which was based on the preoperative, immediate postoperative, and 1-year postoperative magnetic resonance images [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e].\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eA review of clinical, neuroradiographic, neuropsychological findings, and possible mechanisms associated with cerebellar mutism syndrome [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e].\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eThe diffusion abnormalities involving the proximal efferent cerebellar pathway were significantly associated development of posterior fossa syndrome [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e].\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eThe damage of the proximal dentatothalamocortical tract is an important mechanism to understand the occurrence of posterior fossa syndrome [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e].\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eA review with respect to incidence, anatomical substrates, pathophysiology, risk factors, surgical considerations, treatment options, prognosis, and prevention of cerebellar mutism [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eA critical review to reevaluate the information regarding motor speech production post-mutism and chart a mode of recovery of it [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e].\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAn interesting case has been reported and literatures related to the pathophysiologic mechanism of cerebellar mutism have been reviewed [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEffects of magnetic resonance imaging to elucidate cauces and potential pathophysiological machanisms of posterior fossa syndrome [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e].\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eThe cognitive and behavioral impairments in children after cerebellar astrocytoma surgery [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e].\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eA prospective study to compare the severity of speech deficits between tumor survivors with transient cerebellar mutism and those without [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e].\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eA pre-operative scoring system for predicting risk of postoperative pediatric cerebellar mutism syndrome [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e].\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eA review to focus on behavioral and emotional impairments of children with posterior fossa syndrome [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e].\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe time span of citation bursts is represented by red bars in Fig.\u0026nbsp;\u003cspan refid=\"Fig10\" class=\"InternalRef\"\u003e10\u003c/span\u003e. By means of CiteSpace, we chose 15 references with the strongest citation bursts. As depicted in Fig.\u0026nbsp;\u003cspan refid=\"Fig10\" class=\"InternalRef\"\u003e10\u003c/span\u003e, citation bursts for references emerged starting in 2005 and ending in 2018. \u0026ldquo;\u003cem\u003eConsensus paper on post-operative pediatric cerebellar mutism syndrome: the Iceland Delphi results\u003c/em\u003e\u0026rdquo; written by Gudrunardottir, T. et al, had the strongest citation burst (strength\u0026thinsp;=\u0026thinsp;17.39). The citation burst occurred from 2017 to 2022. In short, the burst strength of these 15 references ranged from 6.48 to 17.39, and the time span was from 4 to 6 years. Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e summarizes the main research contents of the 15 references in the order of citation strengths.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e3.7 Hotspots and Frontiers\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eTop 15 keywords on the research of postoperative pediatric cerebellar mutism syndrome.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRank\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eKeywords\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCounts\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedulloblastoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e83\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePosterior fossa syndrome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e61\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCerebellar mutism\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCerebellum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChildren\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePosterior fossa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCerebellar mutism syndrome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMutism\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBrain tumor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePosterior fossa tumor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCognition\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePediatric\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDysarthria\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChild\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNeurosurgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eResearch hotspots in a particular topic could be swiftly identified by using co-occurrence analysis of keywords[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e lists the top 15 high-frequency keywords in the research of ppCMS. Among these keywords, medulloblastoma appeared 83 times, representing the main research direction of ppCMS. We conducted cluster analysis after filtering keywords with more than or equal to 6 occurrences by using VOSviewer (Fig.\u0026nbsp;\u003cspan refid=\"Fig11\" class=\"InternalRef\"\u003e11\u003c/span\u003eA). As displayed in Fig.\u0026nbsp;\u003cspan refid=\"Fig11\" class=\"InternalRef\"\u003e11\u003c/span\u003eA, we obtained six clusters representing six research directions. (1) The keywords in the red cluster consist of ataxia, brain tumor, cerebellar mutism syndrome, child, diffusion tensor imaging, oncology, pediatric brain tumor, pediatric neurosurgery, pediatrics, posterior fossa surgery, posterior fossa tumor, and speech. (2) The keywords in the green cluster consist of astrocytoma, dysarthria, mutism, outcome, pediatric, posterior fossa tumors, and risk factors. (3) The keywords in the blue cluster consist of chemotherapy, magnetic resonance imaging, medulloblastoma, radiotherapy, surgery, and treatment. The keywords in the yellow cluster consist of children, ependymoma, fourth ventricle, hydrocephalus, and posterior fossa. (5) The keywords in the purple cluster consist of cerebellar cognitive affective syndrome, neurosurgery, and posterior fossa syndrome. (6) The keywords in the cyan cluster consist of cerebellum, cognition, MRI, and neuropsychology.\u003c/p\u003e \u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e4.1 Gerneral Information\u003c/h2\u003e \u003cp\u003eThe average publications in the three periods were 8.29 (1999\u0026ndash;2005), 17.86 (2006\u0026ndash;2019), and 34 (2020\u0026ndash;2022), indicating a notable increase in scholarly attention to postoperative pediatric cerebellar mutism syndrome (ppCMS) in recent years. The United States stands out as the primary contributor, with 141 publications (34.39%), surpassing the combined output of Germany, Canada, and England. Close collaboration is observed among North America, Europe, and Oceania, particularly evident in the strong ties between U.S. and Canadian institutions. \u003cem\u003eChild's Nervous System\u003c/em\u003e, with an impact factor of 1.4 (Q3), emerged as the leading journal in ppCMS research. \u003cem\u003eNeuro-oncology\u003c/em\u003e, boasting an impact factor of 15.9 (Q1), leads the journal landscape, followed by the \u003cem\u003eJournal of Neuro-oncology\u003c/em\u003e (impact factor 3.9, Q2). The co-cited journals, predominantly Q1 high-impact publications, provide robust support for ppCMS research.\u003c/p\u003e \u003cp\u003eClinical research dominates the current landscape, with major contributions from authors such as Gajjar, A., Mabbott, D.J., Kumar, R., and Pizer, B. Gajjar's early work in 2006 applied a CMS questionnaire to clinical trials, highlighting the incidence and causes of CMS [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Collaborative articles between Gajjar, A. and Mabbott, D.J. in subsequent years focused on neurobehavioral outcomes and cognitive impairments associated with ppCMS, emphasizing the clinical aspect [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan additionalcitationids=\"CR46\" citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]. Kumar, R. and Pizer, B. through seven co-published papers, delved into the mechanisms and pathophysiology of ppCMS, elucidating aspects such as the bilateral involvement of the proximal efferent cerebellar pathway and perfusion deficits [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan additionalcitationids=\"CR49 CR50\" citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e]. The review conducted in 2020 by Kumar, R. et al [\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e] underscored the importance of comprehensive rehabilitation plans for ppCMS. In conclusion, the evolving landscape of ppCMS research reflects a shift towards increased international collaboration, a surge in annual publications, and a focus on clinical and mechanistic aspects. High-impact journals and prolific authors contribute significantly to advancing our understanding of ppCMS.\u003c/p\u003e \u003cp\u003eSchmahmann, J.D. (citation\u0026thinsp;=\u0026thinsp;246), the most cited author, has significantly influenced the understanding of postoperative pediatric cerebellar mutism syndrome (ppCMS). In 2007, a pivotal paper in \u003cem\u003eCerebellum\u003c/em\u003e marked the initiation of attention to the cognitive and affective functions of the cerebellum [\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e]. Notably, Schmahmann, J.D., and colleagues published a highly impactful article in 2016, addressing the confusion in defining post-operative mutism [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. They proposed a new definition for ppCMS, which has since become widely adopted in subsequent research. Three years later, Schmahmann, J.D. provided a comprehensive overview of cerebellum functions, distinguishing between sensorimotor and cognitive/limbic functions [\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e]. His recent work delves into the origins and evolution of concepts related to ppCMS, cerebellar cognitive affective syndrome (CCAS), and posterior fossa syndrome (PFS) [\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e]. Schmahmann, J.D.'s focus on clarifying foundational definitions and understanding cerebellum functions has laid a robust groundwork for future research in this field.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003e4.2 Knowledge Base\u003c/h2\u003e \u003cp\u003eTo establish the research foundation for postoperative pediatric cerebellar mutism syndrome (ppCMS), we conducted a bibliometric analysis focusing on the 10 co-cited references with the highest co-citations. The seminal work by Pollack, I.F. in 1995, reporting the largest case series until 1999, provided detailed insights into 142 patients undergoing PFT resections, with 8.45% developing CMS. Clinical characteristics outlined the incidence, time course, and radiological features, suggesting bilateral injury to dentate nuclei pathways and edema as potential mechanisms for ppCMS [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. This mechanism aligns with findings from the 3rd co-cited article in 1985 [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The 2nd and 5th co-cited papers identified brainstem invasion, medulloblastoma pathology, midline localization, and vermis incision as significant independent risk factors for ppCMS [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. The 4th and 6th research in the journal of \u003cem\u003eBrain\u003c/em\u003e explored higher-order cerebellar functions through ppCMS cases [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. The 8th article highlighted oral-pharyngeal apraxia as a postoperative complication, emphasizing the relevance of surgical approaches, particularly vermis splitting [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. The 9th article aimed to identify risk factors for ppCMS development [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], while the last co-cited paper elucidated the damage to the proximal dentatothalamocortical tract, crucial for understanding ppCMS anatomical substrates [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003e4.3 Hotspots and Frontiers\u003c/h2\u003e \u003cp\u003eDrawing insights from the keyword clusters (Fig.\u0026nbsp;\u003cspan refid=\"Fig11\" class=\"InternalRef\"\u003e11\u003c/span\u003e) and the main research contents of references with strong citation bursts (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e), it becomes evident that the primary focus of ppCMS research pertains to the mechanisms, risk factors, and clinical manifestations (linguistic, cognitive, and affective disorders). While the clinical manifestations have been explicated in the Introduction, our primary emphasis lies in the exploration of mechanisms and risk factors.\u003c/p\u003e \u003cdiv id=\"Sec16\" class=\"Section3\"\u003e \u003ch2\u003e4.3.1 Mechanisms of ppCMS\u003c/h2\u003e \u003cdiv id=\"Sec17\" class=\"Section4\"\u003e \u003ch2\u003e4.3.1.1 Anatomical substrates\u003c/h2\u003e \u003cp\u003eIn 1995, Pollack, I.F. et al [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e] pointed out that direct damage to the inferior vermian region cannot explain the low incidence and delayed onset of ppCMS. They observed that patients with ppCMS had a significantly increased incidence of bilateral edema of cerebellar peduncles, indicating there may exist a pathway traveling through this structure responsible for initiating speech and other voluntary movements. Most scholars reached the consensus that bilateral disruption to the DTC tract is the major cause of ppCMS [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e, \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e]. Some of them are proven by diffusion magnetic resonance imaging (dMRI) [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e]. After receiving afferent fibers from the lateral hemispheres and primary and supplementary motor area (SMA) of the cerebellum, The DTC pathway starts from the dentate nuclei and then ascends through the superior cerebellar peduncle and the brainstem, crosses over to the next order neurons contralateral ventrolateral nucleus of the thalamus (VL thalamus). Finally, this pathway terminates in the premotor, motor, prefrontal, and frontal cortices [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e]. Theoretically, any damage to this tract may lead to ppCMS. However, few studies can answer the notion of the bilateral cerebellum's participation in motor-speech planning. In 2020, a tractography study published in \u003cem\u003eFrontiers in Neuroanatomy\u003c/em\u003e found that the Crus-Broca tracts, which originated from the bilateral Crus lobe, synapsed in the dentate nucleus, ascended into the superior cerebellar peduncle, passed through the left red nucleus and the left thalamus, and terminated at the subregions of Broca\u0026rsquo;s complex. Conversely, the Broca-Crus tracts originated from the subregions of Broca\u0026rsquo;s complex, and the majority of efferent nerve fibers terminated at the right Crus lobes [\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e]. However, this finding needs further verification.\u003c/p\u003e \u003cp\u003eMoreover, the proximal efferent cerebellar pathway is also a part of the dentato-rubro-olivary pathway (Guillain-Mollaret triangle), which is comprised of the contralateral dentate nucleus, the red nucleus, and the ipsilateral inferior olivary nucleus (ION) [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Disruption to any part of this triangle, especially the dentate nucleus, may cause hypertrophic olivary degeneration (HOD). Two research found that the presence of bilateral HOD was significantly associated with ppCMS occurrence [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e], while the association between unilateral HOD and ppCMS appearance is not always significant [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. For example, a paper published in 2021 did not find such a correlation between HOD and ppCMS [\u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e]. When diagnosis of ppCMS is not sure, HOD can be used as a reliable radiological indicator [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eExamining cognitive and affective disorders, the neuroscience of the cerebellum provides insights into the mechanisms underlying ppCMS. Human brain imaging reveals the involvement of the cognitive cerebellum in the posterior lobe and the limbic cerebellum, likely predominantly represented in the vermis, in distributed neural circuits crucial for cognition and emotion. Cognitive paradigms activate distinct regions within the cerebellar posterior lobe: (1) lobules VI and Crus I for language and verbal working memory; (2) lobule VI for spatial tasks; (3) lobules VI, Crus I, and VIIB for executive functions like working memory, planning, organization, and strategy formation; (4) Vermal lobules VI and VII for emotional processing. Language exhibits a strong right lateralization, and spatial functions show left lateralization, reflecting crossed cerebro-cerebellar projections [\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn summary, elucidating pertinent neuro-conductive pathways and cerebellar functions is integral to a profound comprehension of the mechanisms underlying ppCMS.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section4\"\u003e \u003ch2\u003e4.3.1.2 Perfusion deficits\u003c/h2\u003e \u003cp\u003eThere are findings utilizing single photon emission computed tomography (SPECT) [\u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e, \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e], dynamic susceptibility contrast (DSC) [\u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e], and arterial spin labeling (ASL) [\u003cspan additionalcitationids=\"CR66\" citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e] to detect the cerebral perfusion alterations in children after PFT resection. The association between ppCMS and cerebral hypoperfusion was significant, involving the efferent pathway of the DTC tract, which was ascribed to the cerebella-cerebral diaschisis [\u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e, \u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e]. As bilateral frontal perfusion improved, the symptoms of ppCMS improved [\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e, \u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e]. However, we still need to notice that not all the research confirms these findings and the characteristic of delayed onset needs further elucidation [\u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e]. In a word, more and more articles support this mechanism to explain the characteristics of transient symptoms of ppCMS.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section4\"\u003e \u003ch2\u003e4.3.1.3 Edema\u003c/h2\u003e \u003cp\u003eVasogenic edema is a possible cause of the delayed onset of ppCMS, which needs differentiation with cytotoxic edema through diffusion-weighted imaging (DWI) [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]. The edema may appear in the dentate nucleus, or the afferent or efferent pathways of DTC bilaterally [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e]. However, edema cannot explain the phenomenon that the duration of ppCMS overlasts the remission of postoperative edema [\u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e], suggesting other mechanisms exist.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section3\"\u003e \u003ch2\u003e4.3.2 Risk factors\u003c/h2\u003e \u003cp\u003eA 2022 systematic review and meta-analysis by Pettersson, S.D. et al [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] identified several risk factors for ppCMS, including brainstem invasion, fourth ventricle invasion, superior cerebellar peduncle invasion, diagnosis of medulloblastoma (MB), MB\u0026thinsp;\u0026gt;\u0026thinsp;50 mm, vermis incision, and left-handedness. Protective factors included tumors located in the cerebellar hemisphere, cerebellar hemisphere compression, and intraoperative imaging. Splitting vermis has been proven as a significant risk factor of ppCMS occurrence [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e, \u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e], while whether the telovelar approach could decrease the morbidity of ppCMS remained unclear [\u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e]. Current surgical guidelines for minimizing risk while preserving survival remain unclear. Radiation therapy is recognized as a prominent contributor to neurocognitive deficits, with the radiotherapy dose playing a pivotal role [\u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e]. The impact of chemotherapy on cognitive development is contentious and likely contingent on its toxicity. For instance, Riva et al [\u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e] observed a significant increase in cognitive difficulties among children administered methotrexate compared to other drugs. Subsequent research avenues could investigate: (1) surgical methodologies minimizing the risk of ppCMS; (2) conducting comparative analyses regarding the enduring effects of diverse radiotherapy techniques on long-term language, cognition, and emotional functions over the long term; (3) examining the impact of chemotherapy drugs on long-term language, cognition, and emotional functions. Notably, postoperative patients with posterior fossa tumors necessitate an evaluation of the surgical injury on the neuro-conductive pathway. Given the complexity of clinical manifestations, meticulous and comprehensive recording of ppCMS diagnosis and progression is paramount.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section3\"\u003e \u003ch2\u003e4.3.3 Rehabilitation\u003c/h2\u003e \u003cp\u003eRehabilitation for ppCMS, requiring interdisciplinary collaboration and family involvement, is an underexplored area. Although specific interventions directly targeting ppCMS are lacking, studies on neurocognitive injuries in children with brain tumors provide potential references. Stimulant medications and neurotransmitter modulators, such as donepezil, may enhance attention and focus, while computer-based cognitive intervention programs show promise in improving working memory and addressing learning difficulties [\u003cspan additionalcitationids=\"CR75 CR76 CR77\" citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR78\" class=\"CitationRef\"\u003e78\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003e4.4 Limitations\u003c/h2\u003e \u003cp\u003eInitially, the multitude of diverse and inconsistent definitions for ppCMS posed a challenge, and this heterogeneity in definitions persisted even after the Iceland Delphi results in 2016. This persistence can be attributed to variations in research subjects and etiologies, especially those studies excluding surgical aspects. Moreover, our reliance solely on data from the WoSCC database introduces a potential limitation, as it overlooks contributions from other databases, possibly resulting in the omission of relevant studies. Nonetheless, the Web of Science Core Collection (WoSCC) stands as the most widely utilized database in bibliometric analysis due to its comprehensive dataset, encompassing titles, authors, institutions, countries, abstracts, keywords, references, citation counts, impact factors, and other relevant information [\u003cspan citationid=\"CR79\" class=\"CitationRef\"\u003e79\u003c/span\u003e]. More importantly, due to the format constraints imposed by VOSviewer and CiteSpace, the amalgamation of multiple databases for analysis proved unfeasible. As of now, this technical challenge remains unresolved. Furthermore, the exclusion of non-English papers and publications from 2023 introduces the potential for publication bias, as noteworthy studies in other languages or recent publications may not be captured.\u003c/p\u003e \u003c/div\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eThe escalating number of publications underscores the growing global significance of ppCMS research. Leading the pack are the United States and England, with prominent institutions situated in North America and Europe. Despite this, fostering enhanced collaboration and communication across diverse countries and institutions is imperative. \u003cem\u003eChild's Nervous System\u003c/em\u003e stands out as the most widely recognized journal, with numerous co-citations, predominantly originating from high-impact Q1 journals. Scholars predominantly concentrate on unraveling the mechanisms, risk factors, and clinical features of ppCMS. Areas requiring in-depth exploration include: (1) elucidating relevant neuro-conductive pathways and cerebellar functions; (2) developing surgical guidelines to minimize the risk of ppCMS; (3) conducting comparative analyses of the enduring effects of diverse radiotherapy techniques on long-term language, cognition, and emotional functions; (4) investigating the impact of chemotherapy drugs on sustained language, cognition, and emotional functions.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAM: akinetic mutism\u003c/p\u003e\n\u003cp\u003eASL: arterial spin labeling\u003c/p\u003e\n\u003cp\u003eCCAS: cerebellar cognitive affective syndrome\u003c/p\u003e\n\u003cp\u003eCM: cerebellar mutism\u003c/p\u003e\n\u003cp\u003eCMS: cerebellar mutism syndrome\u003c/p\u003e\n\u003cp\u003edMRI: diffusion magnetic resonance imaging\u003c/p\u003e\n\u003cp\u003eDSC: dynamic susceptibility contrast\u003c/p\u003e\n\u003cp\u003eDWI: diffusion-weighted imaging\u003c/p\u003e\n\u003cp\u003eHOD: hypertrophic olivary degeneration\u003c/p\u003e\n\u003cp\u003eION: inferior olivary nucleus\u003c/p\u003e\n\u003cp\u003epCMS: postoperative cerebellar mutism syndrome\u003c/p\u003e\n\u003cp\u003ePFS: posterior fossa syndrome\u003c/p\u003e\n\u003cp\u003ePFT: posterior fossa tumor\u003c/p\u003e\n\u003cp\u003eppCMS: Post-operative pediatric cerebellar mutism syndrome\u003c/p\u003e\n\u003cp\u003eMB: medulloblastoma\u003c/p\u003e\n\u003cp\u003eMSD: subsequent dysarthria\u003c/p\u003e\n\u003cp\u003eSMA: supplementary motor area\u003c/p\u003e\n\u003cp\u003eSPECT: single photon emission computed tomography\u003c/p\u003e\n\u003cp\u003eTCM: transient cerebellar mutism\u003c/p\u003e\n\u003cp\u003eWoSCC: Web of Science Core Collection\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets supporting the conclusions drawn in this article can be made accessible by contacting the corresponding authors through a reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that there are no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eQingtian Liang was the lead author and designed the study. Yizhi Du and Zhuqing Cheng were responsible for the introduction, literature search, and data collection. Qingtian Liang and Zuqing Wu were responsible for the results, including data analysis and table/figure creation. Qingtian Liang, Zuqing Wu, and Sihan Zhu were responsible for the discussion. Sihan Zhu, Qingtian Liang, Yinsheng Chen, Xiangheng Zhang, Jian Wang, and Fuhua Lin were responsible for the article revision. All authors contributed to the article and approved the submitted version.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank those individuals who made the VOSviewer, the R package “bibliometricx”, and CiteSpace open-source software available.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eDaly DD, Love JG. Akinetic mutism. Neurology. 1958 Mar;8(3):238\u0026ndash;42. \u003c/li\u003e\n\u003cli\u003eRekate HL, Grubb RL, Aram DM, Hahn JF, Ratcheson RA. Muteness of cerebellar origin. Arch Neurol. 1985 Jul;42(7):697\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eRobertson PL, Muraszko KM, Holmes EJ, Sposto R, Packer RJ, Gajjar A, et al. Incidence and severity of postoperative cerebellar mutism syndrome in children with medulloblastoma: a prospective study by the Children\u0026rsquo;s Oncology, Group. JOURNAL OF NEUROSURGERY. 2006 Dec;105(6):444\u0026ndash;51. \u003c/li\u003e\n\u003cli\u003evan Dongen HR, Catsman-Berrevoets CE, van Mourik M. The syndrome of \u0026ldquo;cerebellar\u0026rdquo; mutism and subsequent dysarthria. Neurology. 1994 Nov;44(11):2040\u0026ndash;6. \u003c/li\u003e\n\u003cli\u003eVan Calenbergh F, Van de Laar A, Plets C, Goffin J, Casaer P. Transient cerebellar mutism after posterior fossa surgery in children. Neurosurgery. 1995 Nov;37(5):894\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eSchmahmann JD, Sherman JC. Cerebellar cognitive affective syndrome. Int Rev Neurobiol. 1997;41:433\u0026ndash;40. \u003c/li\u003e\n\u003cli\u003eSchmahmann JD, Sherman JC. The cerebellar cognitive affective syndrome. Brain. 1998 Apr;121 ( Pt 4):561\u0026ndash;79. \u003c/li\u003e\n\u003cli\u003eGudrunardottir T, Morgan AT, Lux AL, Walker DA, Walsh KS, Wells EM, et al. Consensus paper on post-operative pediatric cerebellar mutism syndrome: the Iceland Delphi results. CHILDS NERVOUS SYSTEM. 2016 Jul;32(7):1195\u0026ndash;203. \u003c/li\u003e\n\u003cli\u003eToescu SM, Hales PW, Cooper J, Dyson EW, Mankad K, Clayden JD, et al. Arterial Spin-Labeling Perfusion Metrics in Pediatric Posterior Fossa Tumor Surgery. Am J Neuroradiol. 2022;43(10):1508\u0026ndash;15. \u003c/li\u003e\n\u003cli\u003eJabarkheel R, Amayiri N, Yecies D, Huang Y, Toescu S, Nobre L, et al. Molecular correlates of cerebellar mutism syndrome in medulloblastoma. NEURO-ONCOLOGY. 2020 Feb;22(2):290\u0026ndash;7. \u003c/li\u003e\n\u003cli\u003eSpiteri M, Guillemaut JY, Windridge D, Avula S, Kumar R, Lewis E. Fully-Automated Identification of Imaging Biomarkers for Post-Operative Cerebellar Mutism Syndrome Using Longitudinal Paediatric MRI. NEUROINFORMATICS. 2020 Jan;18(1):151\u0026ndash;62. \u003c/li\u003e\n\u003cli\u003eSchreiber JE, Palmer SL, Conklin HM, Mabbott DJ, Swain MA, Bonner MJ, et al. Posterior fossa syndrome and long-term neuropsychological outcomes among children treated for medulloblastoma on a multi-institutional, prospective study. NEURO-ONCOLOGY. 2017 Dec;19(12):1673\u0026ndash;82. \u003c/li\u003e\n\u003cli\u003eAvula S, Spiteri M, Kumar R, Lewis E, Harave S, Windridge D, et al. Post-operative pediatric cerebellar mutism syndrome and its association with hypertrophic olivary degeneration. QUANTITATIVE IMAGING IN MEDICINE AND SURGERY. 2016 Oct;6(5):535\u0026ndash;44. \u003c/li\u003e\n\u003cli\u003ePerreault S, Lober RM, Cheshier S, Partap S, Edwards MS, Yeom KW. Time-dependent structural changes of the dentatothalamic pathway in children treated for posterior fossa tumor. Am J Neuroradiol. 2014;35(4):803\u0026ndash;7. \u003c/li\u003e\n\u003cli\u003eLewison G, Devey ME. Bibliometric methods for the evaluation of arthritis research. Rheumatology (Oxford). 1999 Jan;38(1):13\u0026ndash;20. \u003c/li\u003e\n\u003cli\u003eWu F, Gao J, Kang J, Wang X, Niu Q, Liu J, et al. Knowledge Mapping of Exosomes in Autoimmune Diseases: A Bibliometric Analysis (2002\u0026ndash;2021). Front Immunol. 2022 Jul 22;13:939433. \u003c/li\u003e\n\u003cli\u003eNinkov A, Frank JR, Maggio LA. Bibliometrics: Methods for studying academic publishing. Perspect Med Educ. 2022 Jun;11(3):173\u0026ndash;6. \u003c/li\u003e\n\u003cli\u003eArruda H, Silva ER, Lessa M, Proen\u0026ccedil;a D, Bartholo R. VOSviewer and Bibliometrix. J Med Libr Assoc. 2022 Jul 1;110(3):392\u0026ndash;5. \u003c/li\u003e\n\u003cli\u003eChen C, Song M. Visualizing a field of research: A methodology of systematic scientometric reviews. PLOS ONE. 2019 Oct 31;14(10):e0223994. \u003c/li\u003e\n\u003cli\u003eAshida R, Nazar N, Edwards R, Teo M. Cerebellar Mutism Syndrome: An Overview of the Pathophysiology in Relation to the Cerebrocerebellar Anatomy, Risk Factors, Potential Treatments, and Outcomes. WORLD NEUROSURGERY. 2021 Sep;153:63\u0026ndash;74. \u003c/li\u003e\n\u003cli\u003evan Baarsen KM, Grotenhuis JA. The anatomical substrate of cerebellar mutism. MEDICAL HYPOTHESES. 2014 Jun;82(6):774\u0026ndash;80. \u003c/li\u003e\n\u003cli\u003eGudrunardottir T, Sehested A, Juhler M, Schmiegelow K. Cerebellar mutism. CHILDS NERVOUS SYSTEM. 2011 Mar;27(3):355\u0026ndash;63. \u003c/li\u003e\n\u003cli\u003eOzgur BM, Berberian J, Aryan HE, Meltzer HS, Levy ML. The pathophysiologic mechanism of cerebellar mutism. SURGICAL NEUROLOGY. 2006 Jul;66(1):18\u0026ndash;25. \u003c/li\u003e\n\u003cli\u003ePettersson SD, Kitlinski M, Miekisiak G, Ali S, Krakowiak M, Szmuda T. Risk factors for postoperative cerebellar mutism syndrome in pediatric patients: a systematic review and meta-analysis. JOURNAL OF NEUROSURGERY-PEDIATRICS. 2022 Apr;29(4):467\u0026ndash;75. \u003c/li\u003e\n\u003cli\u003evan Eck NJ, Waltman L. Software survey: VOSviewer, a computer program for bibliometric mapping. Scientometrics. 2010 Aug;84(2):523\u0026ndash;38. \u003c/li\u003e\n\u003cli\u003eZeng L, Ma G, Chen K, Zhou Q. Bibliometric analysis of rheumatic immune related adverse events associated with immune checkpoint inhibitors. Front Immunol. 2023;14:1242336. \u003c/li\u003e\n\u003cli\u003eSynnestvedt MB, Chen C, Holmes JH. CiteSpace II: visualization and knowledge discovery in bibliographic databases. AMIA Annu Symp Proc. 2005;2005:724\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eHuang X, Fan X, Ying J, Chen S. Emerging trends and research foci in gastrointestinal microbiome. J Transl Med. 2019 Dec;17(1):67. \u003c/li\u003e\n\u003cli\u003ePollack IF, Polinko P, Albright AL, Towbin R, Fitz C. Mutism and pseudobulbar symptoms after resection of posterior fossa tumors in children: incidence and pathophysiology. Neurosurgery. 1995 Nov;37(5):885\u0026ndash;93. \u003c/li\u003e\n\u003cli\u003eLevisohn L, Cronin-Golomb A, Schmahmann JD. Neuropsychological consequences of cerebellar tumour resection in children - Cerebellar cognitive affective syndrome in a paediatric population. BRAIN. 2000 May;123:1041\u0026ndash;50. \u003c/li\u003e\n\u003cli\u003eCatsman-Berrevoets CE, Van Dongen HR, Mulder PG, Paz y Geuze D, Paquier PF, Lequin MH. Tumour type and size are high risk factors for the syndrome of \u0026ldquo;cerebellar\u0026rdquo; mutism and subsequent dysarthria. J Neurol Neurosurg Psychiatry. 1999 Dec;67(6):755\u0026ndash;7. \u003c/li\u003e\n\u003cli\u003eRiva D, Giorgi C. The cerebellum contributes to higher functions during development: evidence from a series of children surgically treated for posterior fossa tumours. Brain. 2000 May;123 ( Pt 5):1051\u0026ndash;61. \u003c/li\u003e\n\u003cli\u003eDailey AT, McKhann GM, Berger MS. The pathophysiology of oral pharyngeal apraxia and mutism following posterior fossa tumor resection in children. J Neurosurg. 1995 Sep;83(3):467\u0026ndash;75. \u003c/li\u003e\n\u003cli\u003eMorris EB, Phillips NS, Laningham FH, Patay Z, Gajjar A, Wallace D, et al. Proximal dentatothalamocortical tract involvement in posterior fossa syndrome. BRAIN. 2009 Nov;132:3087\u0026ndash;95. \u003c/li\u003e\n\u003cli\u003eLaw N, Greenberg M, Bouffet E, Taylor MD, Laughlin S, Strother D, et al. Clinical and neuroanatomical predictors of cerebellar mutism syndrome. NEURO-ONCOLOGY. 2012 Oct;14(10):1294\u0026ndash;303. \u003c/li\u003e\n\u003cli\u003eWells EM, Khademian ZP, Walsh KS, Vezina G, Sposto R, Keating RF, et al. Postoperative cerebellar mutism syndrome following treatment of medulloblastoma: neuroradiographic features and origin Clinical article. JOURNAL OF NEUROSURGERY-PEDIATRICS. 2010 Apr;5(4):329\u0026ndash;34. \u003c/li\u003e\n\u003cli\u003eWells EM, Walsh KS, Khademian ZP, Keating RF, Packer RJ. THE CEREBELLAR MUTISM SYNDROME AND ITS RELATION TO CEREBELLAR COGNITIVE FUNCTION AND THE CEREBELLAR COGNITIVE AFFECTIVE DISORDER. DEVELOPMENTAL DISABILITIES RESEARCH REVIEWS. 2008;14(3):221\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eAvula S, Kumar R, Pizer B, Pettorini B, Abernethy L, Garlick D, et al. Diffusion abnormalities on intraoperative magnetic resonance imaging as an early predictor for the risk of posterior fossa syndrome. Neuro-Oncology. 2015 Apr 1;17(4):614\u0026ndash;22. \u003c/li\u003e\n\u003cli\u003eDe Smet HJ, Baillieux H, Catsman-Berrevoets C, De Deyn PP, Marien P, Paquier PF. Postoperative motor speech production in children with the syndrome of \u0026ldquo;cerebellar\u0026rdquo; mutism and subsequent dysarthria: A critical review of the literature. EUROPEAN JOURNAL OF PAEDIATRIC NEUROLOGY. 2007 Jul;11(4):193\u0026ndash;207. \u003c/li\u003e\n\u003cli\u003ePatay Z. Postoperative posterior fossa syndrome: unraveling the etiology and underlying pathophysiology by using magnetic resonance imaging. CHILDS NERVOUS SYSTEM. 2015 Oct;31(10):1853\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eAarsen FK, Van Dongen HR, Paquier PF, Van Mourik M, Catsman-Berrevoets CE. Long-term sequelae in children after cerebellar astrocytoma surgery. Neurology. 2004 Apr 27;62(8):1311\u0026ndash;6. \u003c/li\u003e\n\u003cli\u003eHuber JF, Bradley K, Spiegler BJ, Dennis M. Long-term effects of transient cerebellar mutism after cerebellar astrocytoma or medulloblastoma tumor resection in childhood. CHILDS NERVOUS SYSTEM. 2006 Feb;22(2):132\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eLiu JF, Dineen RA, Avula S, Chambers T, Dutta M, Jaspan T, et al. Development of a pre-operative scoring system for predicting risk of post-operative paediatric cerebellar mutism syndrome. British Journal of Neurosurgery. 2018 Jan 2;32(1):18\u0026ndash;27. \u003c/li\u003e\n\u003cli\u003eLanier JC, Abrams AN. Posterior Fossa Syndrome: Review of the Behavioral and Emotional Aspects in Pediatric Cancer Patients. CANCER. 2017 Feb 15;123(4):551\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003ePalmer SL, Hassall T, Evankovich K, Mabbott DJ, Bonner M, Deluca C, et al. Neurocognitive outcome 12 months following cerebellar mutism syndrome in pediatric patients with medulloblastoma. NEURO-ONCOLOGY. 2010 Dec;12(12):1311\u0026ndash;7. \u003c/li\u003e\n\u003cli\u003eKnight SJ, Conklin HM, Palmer SL, Schreiber JE, Armstrong CL, Wallace D, et al. Working Memory Abilities Among Children Treated for Medulloblastoma: Parent Report and Child Performance. JOURNAL OF PEDIATRIC PSYCHOLOGY. 2014 Jun;39(5):501\u0026ndash;11. \u003c/li\u003e\n\u003cli\u003eSchreiber JE, Gurney JG, Palmer SL, Bass JK, Wang M, Chen S, et al. Examination of risk factors for intellectual and academic outcomes following treatment for pediatric medulloblastoma. NEURO-ONCOLOGY. 2014 Aug;16(8):1129\u0026ndash;36. \u003c/li\u003e\n\u003cli\u003eZakaria R, Ellenbogen J, Graham C, Pizer B, Mallucci C, Kumar R. A decision analysis tool for the assessment of posterior fossa tumour surgery outcomes in children-the \u0026ldquo;Liverpool Neurosurgical Complication Causality Assessment Tool.\u0026rdquo; CHILDS NERVOUS SYSTEM. 2013 Aug;29(8):1277\u0026ndash;83. \u003c/li\u003e\n\u003cli\u003eAvula S, Mallucci C, Kumar R, Pizer B. Posterior fossa syndrome following brain tumour resection: review of pathophysiology and a new hypothesis on its pathogenesis. CHILDS NERVOUS SYSTEM. 2015 Oct;31(10):1859\u0026ndash;67. \u003c/li\u003e\n\u003cli\u003eHartley H, Pizer B, Lane S, Sneade C, Williams R, Mallucci C, et al. Incidence and prognostic factors of ataxia in children with posterior fossa tumors. NEURO-ONCOLOGY PRACTICE. 2019 Jun;6(3):185\u0026ndash;93. \u003c/li\u003e\n\u003cli\u003eDeghedy M, Pizer B, Kumar R, Mallucci C, Avula S. Basilar Artery Vasospasm as a Cause of Post-Operative Cerebellar Mutism Syndrome. CASE REPORTS IN PEDIATRICS. 2022 Feb 10;2022:9148100. \u003c/li\u003e\n\u003cli\u003ePaquier PF, Walsh KS, Docking KM, Hartley H, Kumar R, Catsman-Berrevoets CE. Post-operative cerebellar mutism syndrome: rehabilitation issues. CHILDS NERVOUS SYSTEM. 2020 Jun;36(6):1215\u0026ndash;22. \u003c/li\u003e\n\u003cli\u003eSchmahmann JD, Weilburg JB, Sherman JC. The neuropsychiatry of the cerebellum - insights from the clinic. CEREBELLUM. 2007;6(3):254\u0026ndash;67. \u003c/li\u003e\n\u003cli\u003eSchmahmann JD. The cerebellum and cognition. NEUROSCIENCE LETTERS. 2019 Jan 1;688:62\u0026ndash;75. \u003c/li\u003e\n\u003cli\u003eSchmahmann JD. Pediatric post-operative cerebellar mutism syndrome, cerebellar cognitive affective syndrome, and posterior fossa syndrome: historical review and proposed resolution to guide future study. CHILDS NERVOUS SYSTEM. 2020 Jun;36(6):1205\u0026ndash;14. \u003c/li\u003e\n\u003cli\u003eToescu SM, Hales PW, Kaden E, Lacerda LM, Aquilina K, Clark CA. Tractographic and Microstructural Analysis of the Dentato-Rubro-Thalamo-Cortical Tracts in Children Using Diffusion MRI. CEREBRAL CORTEX. 2021 May;31(5):2595\u0026ndash;609. \u003c/li\u003e\n\u003cli\u003ePuget S, Boddaert N, Viguier D, Kieffer V, Bulteau C, Garnett M, et al. Injuries to Inferior Vermis and Dentate Nuclei Predict Poor Neurological and Neuropsychological Outcome in Children With Malignant Posterior Fossa Tumors. CANCER. 2009 Mar 15;115(6):1338\u0026ndash;47. \u003c/li\u003e\n\u003cli\u003eGadgil N, Hansen D, Barry J, Chang R, Lam S. Posterior fossa syndrome in children following tumor resection: Knowledge update. Surg Neurol Int. 2016;7(Suppl 6):S179-183. \u003c/li\u003e\n\u003cli\u003eZhang H, Bao Y, Feng Y, Hu H, Wang Y. Evidence for Reciprocal Structural Network Interactions Between Bilateral Crus Lobes and Broca\u0026rsquo;s Complex. FRONTIERS IN NEUROANATOMY. 2020 Jun 18;14:27. \u003c/li\u003e\n\u003cli\u003eBeez T, Munoz-Bendix C, Mijderwijk HJ, Remke M, Haenggi D. Structural damage burden and hypertrophic olivary degeneration in pediatric postoperative cerebellar mutism syndrome. NEUROSURGICAL REVIEW. 2022 Aug;45(4):2757\u0026ndash;65. \u003c/li\u003e\n\u003cli\u003eSchaller-Paule MA, Baumgarten P, Seifert V, Wagner M, Steidl E, Hattingen E, et al. A Paravermal Trans-Cerebellar Approach to the Posterior Fossa Tumor Causes Hypertrophic Olivary Degeneration by Dentate Nucleus Injury. Cancers (Basel). 2021 Jan 12;13(2):258. \u003c/li\u003e\n\u003cli\u003eCatsman-Berrevoets CE, Aarsen FK. The spectrum of neurobehavioural deficits in the Posterior Fossa Syndrome in children after cerebellar tumour surgery. CORTEX. 2010 Aug;46(7):933\u0026ndash;46. \u003c/li\u003e\n\u003cli\u003eDe Smet HJ, Baillieux H, Wackenier P, De Praeter M, Engelborghs S, Paquier PF, et al. Long-Term Cognitive Deficits Following Posterior Fossa Tumor Resection: A Neuropsychological and Functional Neuroimaging Follow-Up Study. NEUROPSYCHOLOGY. 2009 Nov;23(6):694\u0026ndash;704. \u003c/li\u003e\n\u003cli\u003eMiller NG, Reddick WE, Kocak M, Glass JO, Loebel U, Morris B, et al. Cerebellocerebral Diaschisis Is the Likely Mechanism of Postsurgical Posterior Fossa Syndrome in Pediatric Patients with Midline Cerebellar Tumors. AMERICAN JOURNAL OF NEURORADIOLOGY. 2010 Feb;31(2):288\u0026ndash;94. \u003c/li\u003e\n\u003cli\u003eBoisgontier J, Fillon L, Rutten C, Saitovitch A, Dufour C, Lemaitre H, et al. A CBF decrease in the left supplementary motor areas: New insight into postoperative pediatric cerebellar mutism syndrome using arterial spin labeling perfusion MRI. JOURNAL OF CEREBRAL BLOOD FLOW AND METABOLISM. 2021 Dec;41(12):3339\u0026ndash;49. \u003c/li\u003e\n\u003cli\u003eYecies D, Shpanskaya K, Jabarkheel R, Maleki M, Bruckert L, Cheshier SH, et al. Arterial spin labeling perfusion changes of the frontal lobes in children with posterior fossa syndrome. JOURNAL OF NEUROSURGERY-PEDIATRICS. 2019 Oct;24(4):382\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eWatanabe Y, Yamasaki F, Nakamura K, Kajiwara Y, Takayasu T, Nosaka R, et al. Evaluation of cerebellar mutism by arterial spin-labeling perfusion magnetic resonance imaging in a patient with atypical teratoid/rhabdoid tumor (AT/RT): a case report. CHILDS NERVOUS SYSTEM. 2012 Aug;28(8):1257\u0026ndash;60. \u003c/li\u003e\n\u003cli\u003eErsahin Y, Yararbas \u0026Uuml;, Duman Y, Mutluer S. Single photon emission tomography following posterior fossa surgery in patients with and without mutism. CHILDS NERVOUS SYSTEM. 2002 Jul;18(6\u0026ndash;7):318\u0026ndash;25. \u003c/li\u003e\n\u003cli\u003eSiffert J, Poussaint TY, Goumnerova LC, Scott RM, LaValley B, Tarbell NJ, et al. Neurological dysfunction associated with postoperative cerebellar mutism. JOURNAL OF NEURO-ONCOLOGY. 2000 May;48(1):75\u0026ndash;81. \u003c/li\u003e\n\u003cli\u003eGrill J, Viguier D, Kieffer V, Bulteau C, Sainte-Rose C, Hartmann O, et al. Critical risk factors for intellectual impairment in children with posterior fossa tumors: the role of cerebellar damage. JOURNAL OF NEUROSURGERY. 2004 Nov;101(2):152\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eTamburrini G, Frassanito P, Chieffo D, Massimi L, Caldarelli M, Di Rocco C. Cerebellar mutism. Childs Nerv Syst. 2015 Oct;31(10):1841\u0026ndash;51. \u003c/li\u003e\n\u003cli\u003ede Speville ED, Kieffer V, Dufour C, Grill J, Noulhiane M, Hertz-Pannier L, et al. Neuropsychological consequences of childhood medulloblastoma and possible interventions: A review. NEUROCHIRURGIE. 2021 Feb;67(1):90\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eRiva D, Giorgi C, Nichelli F, Bulgheroni S, Massimino M, Cefalo G, et al. Intrathecal methotrexate affects cognitive function in children with medulloblastoma. Neurology. 2002 Jul 9;59(1):48\u0026ndash;53. \u003c/li\u003e\n\u003cli\u003eMulhern RK, Khan RB, Kaplan S, Helton S, Christensen R, Bonner M, et al. Short-term efficacy of methylphenidate: a randomized, double-blind, placebo-controlled trial among survivors of childhood cancer. J Clin Oncol. 2004 Dec 1;22(23):4795\u0026ndash;803. \u003c/li\u003e\n\u003cli\u003eThompson SJ, Leigh L, Christensen R, Xiong X, Kun LE, Heideman RL, et al. Immediate neurocognitive effects of methylphenidate on learning-impaired survivors of childhood cancer. J Clin Oncol. 2001 Mar 15;19(6):1802\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eCastellino SM, Tooze JA, Flowers L, Hill DF, McMullen KP, Shaw EG, et al. Toxicity and efficacy of the acetylcholinesterase (AChe) inhibitor donepezil in childhood brain tumor survivors: a pilot study. Pediatr Blood Cancer. 2012 Sep;59(3):540\u0026ndash;7. \u003c/li\u003e\n\u003cli\u003eCox LE, Ashford JM, Clark KN, Martin-Elbahesh K, Hardy KK, Merchant TE, et al. Feasibility and acceptability of a remotely administered computerized intervention to address cognitive late effects among childhood cancer survivors. Neurooncol Pract. 2015 Jun;2(2):78\u0026ndash;87. \u003c/li\u003e\n\u003cli\u003eHardy KK, Willard VW, Allen TM, Bonner MJ. Working memory training in survivors of pediatric cancer: a randomized pilot study. Psychooncology. 2013 Aug;22(8):1856\u0026ndash;65. \u003c/li\u003e\n\u003cli\u003eDing X, Yang Z. Knowledge mapping of platform research: a visual analysis using VOSviewer and CiteSpace. Electron Commer Res. 2022 Sep;22(3):787\u0026ndash;809. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcan","sideBox":"Learn more about [BMC Cancer](http://bmccancer.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcan/default.aspx","title":"BMC Cancer","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"bibliometrics, post-operative cerebellar mutism syndrome, posterior fossa syndrome, cerebellar mutism, cerebellar mutism syndrome","lastPublishedDoi":"10.21203/rs.3.rs-4443326/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4443326/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003ePost-operative pediatric cerebellar mutism syndrome (ppCMS) is a common neurological complication characterized by delayed onset mutism, emotional lability, hypotonia, and oropharyngeal dysfunction following resection of a posterior fossa tumor in children. The objective of this study is to visually depict the knowledge structure and pinpoint research hotspots within the field using bibliometric analysis.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e \u003cp\u003ePublications related to ppCMS from 1999 to 2022 were searched on the Web of Science Core Collection (WoSCC) database. VOSviewer, R package, \u0026ldquo;bibliometrix\u0026rdquo;, and CiteSpace were used to draw and analyze corresponding visualization maps.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003e410 articles from 52 countries led by the United States of America (USA) and England were included. The number of published papers is on the rise in general. Hospital for Sick Children (Canada), St. Jude Children\u0026rsquo;s Research Hospital (USA), University Toronto (Canada), Texas Children\u0026rsquo;s Hospital (USA), and Children\u0026rsquo;s National Hospital (USA) are the main research institutions. Child\u0026rsquo;s Nervous System is the most popular and the most co-cited journal in this domain. These publications come from 2091 authors. Gajjar, A. has published the most papers, and the papers authored by Schmahmann, J.D. have been co-cited the most. The mechanisms, risk factors, and clinical manifestations of ppCMS occurrence and development are the main topics in this field. The most commonly used keywords are medulloblastoma, posterior fossa syndrome, cerebellar mutism, cerebellum, and children.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThis is the first bibliometric analysis to comprehensively overview the active research areas and development of ppCMS, which will provide a reference for scholars studying this field.\u003c/p\u003e","manuscriptTitle":"The Research Trends of Post-operative Pediatric Cerebellar Mutism Syndrome: A Bibliometric Analysis (1999-2022)","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-07 19:02:08","doi":"10.21203/rs.3.rs-4443326/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorAssigned","content":"","date":"2024-05-27T13:23:36+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-05-23T07:22:04+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Cancer","date":"2024-05-19T07:21:46+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcan","sideBox":"Learn more about [BMC Cancer](http://bmccancer.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcan/default.aspx","title":"BMC Cancer","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ededd4c4-5d21-41f9-80ff-f1269eb75b4f","owner":[],"postedDate":"June 7th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2024-06-07T19:02:08+00:00","versionOfRecord":[],"versionCreatedAt":"2024-06-07 19:02:08","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4443326","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4443326","identity":"rs-4443326","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}