Analysis of risk factors and language rehabilitation nursing strategies for CMS after pediatric medulloblastoma surgery

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Methods The clinical data of 217 children with medulloblastoma who underwent tumor resection in pediatric neurosurgery of comprehensive first- class hospital in Beijing from April 2019 to March 2022 were retrospectively analyzed. According to the consensus of Iceland Delphi, CMS was diagnosed. According to whether CMS occurred after surgery, they were divided into CMS group and non CMS group, Logistic regression analysis was used to identify the risk factors for CMS in children with medulloblastoma after surgery. Results Out of 217 children with medulloblastoma, 36 developed CMS after surgery, with an incidence rate of 16.6%. The results of logistic regression analysis showed that tumor infiltration into the pons, supratentorial hydrocephalus, and intraoperative blood transfusion were risk factors for postoperative CMS in children with medulloblastoma. Conclusion The incidence of CMS in children with medulloblastoma after surgery is relatively high. Tumor infiltration into the pons, supratentorial hydrocephalus, and intraoperative blood transfusion can diagnose the occurrence of CMS in children with medulloblastoma after surgery. Nursing staff should pay attention to the mutism symptoms of children with medulloblastoma after surgery, and implement early language rehabilitation nursing interventions. Medulloblastoma CMS Risk factors Language rehabilitation Nursing Background Cerebellar mutism syndrome (CMS) is a complex group of neurological and cognitive-psychological clinical signs and symptoms [1] and is a common complication after posterior fossa tumours with a prevalence of 8%-40% [2, 3], with the highest prevalence of 30%-39% [4-6]after medulloblastoma in children.The incubation period of CMS is typically 1-6 days and is distinguished by transient postoperative muteness, speech disturbance, and emotional lability. Other prevalent symptoms include hypotonia, oropharyngeal dysfunction, dysphagia, ataxia, dysarthria, cognitive dysfunction, and dysfunction of the bowel and bladder[2,3,7]. However, it is not uncommon for speech and language to fail to return to a state of normality, with other cognitive and motor deficits also persisting[7]. There is no conclusive evidence regarding the risk factors for postoperative complications of CMS in children with tumours of the posterior cranial fossa.The existing literature suggests that brainstem invasion or compression by lesions, the nature of tumours in the posterior cranial fossa, hydrocephalus, and central nervous system infections may be risk factors for the development of CMS[8,9]. However, the results of previous studies on these same influencing factors are still inconsistent, and the sample sizes are relatively small[9]. Furthermore, the data from multiple studies included in the meta-analysis of CMS risk factors could not be extracted. Additionally, the results of the studies included in the meta-analysis have some bias[10]. There is still a gap in the studies of CMS in children with medulloblastoma after surgery in China.Furthermore,research has demonstrated that there is no established,evidence-based treatment for CMS speech disorders. Non-pharmacological interventions are of greater importance than pharmacological treatments [3]. Consequently, this study retrospectively examines the incidence and contributing factors of postoperative CMS in children with medulloblastoma and explores the nursing strategies for postoperative speech function rehabilitation of these children. The objective is to provide a foundation for the intervention and prevention of postoperative CMS in children with medulloblastoma. Methods Study design We conducted a single-center, retrospective cohort study. This study was approved by the Medical Ethics Committee of Beijing Tiantan Hospital of Capital Medical University.（approval number KY2022-067-01）,all patients gave their written informed consent for publication. Participants A retrospective analysis was conducted on the occurrence of postoperative CMS in 217 children with medulloblastoma who underwent tumour resection at our hospital between April 2019 and March 2022. The cohort consisted of 151 males and 66 females with a mean age of 7.42±3.42 years. The inclusion criteria were as follows: Inclusion criteria: ①age ≤18 years; ② complete preoperative head CT and MRI imaging data; ③postoperative pathological diagnosis of medulloblastoma; ④complete postoperative follow-up data; ⑤not combined with other diseases affecting children's intelligence and language function. Exclusion criteria: ①combined with serious heart, brain, liver, kidney or gastrointestinal disease; ②incomplete clinical data; ③diagnosed with mental illness. Survey tools ①A self-designed questionnaire was employed, comprising demographic and disease-related information. Demographic data included sex and age; disease-related data included whether the maximum diameter of the tumour was ≥5 cm, pathological staging, whether the tumour infiltrated or compressed the saddle region, whether the anterior third ventricle was herniated, whether there was structural crowding of the greater occipital foramen, whether the tumour infiltrated or compressed the brainstem, and whether the tumour Infiltration of the fourth ventricle, supratentorial cerebellar vermis, right cerebellar hemisphere, left cerebellar hemisphere, pontine brain, and supratentorial hydrocephalus were also assessed. In addition, the following factors were considered: whether the tumour infiltrated the left frontal region, the number of post-operative symptoms (cognitive dysfunction, ataxia, dysarthria, apathy, emotional lability, anorexia, dysuria, etc.), the duration of the operation, the type of tumour, the location of the tumour, the location of the tumour on the brain stem, and the location of the tumour on the brain stem. Additionally, the following variables were considered: the duration of surgery, the amount of intraoperative bleeding, the amount of blood transfused during surgery, the amount of postoperative temperature rise on the third day after surgery, the amount of postoperative central nervous system infection, and the amount of postoperative mannitol used.②The objective of this study was to ascertain whether children with medulloblastoma who underwent surgery subsequently developed CMS (CMS). To this end, the Icelandic Delphi consensus was employed as a criterion, and the children were classified into two groups: the CMS group and the non-CMS group. The former was defined according to the medical records of the postoperative course. Data collection A research team comprising a specialist neurosurgical nurse, a specialist rehabilitation nurse, the head nurse and a doctor was established on the ward with the objective of gathering data and completing questionnaires on paediatric patients with medulloblastoma. This entailed following the case from admission to discharge, consulting the electronic medical record system, the electronic imaging system, the nursing notes, the surgical notes, the anaesthesia notes and other relevant documentation. Statistical analysis The statistical analyses were conducted using the statistical software package SPSS 25.0. Continuous data were described using mean ± standard deviation or median and interquartile range, while categorical data were described using frequency and percentage (%). A chi-squared test was employed to ascertain any differences between the children's demographic and disease-related information and the presence of CMS. Variables that were found to be significant in the univariate analysis were included in the regression analysis. Logistic regression was used to analyse the effect of demographic and disease-related information on the presence or absence of cerebellar vermis syndrome in children after surgery. The level of statistical significance was set at p < 0.05. Results Occurrence of CMS in children with medulloblastoma The incidence of postoperative cerebellar dysmorphic disorder in children with medulloblastoma was 16.6% (36/217). This was observed among children who underwent tumour resection between April 2019 and March 2022. Results of single factor analysis The findings demonstrated that the incidence of postoperative CMS was higher in children with medulloblastoma with pathologic staging of atypical, obstructive structure of the occipital foramen, tumour invasion of the fourth ventricle, tumour invasion of the pons, supratentorial hydrocephalus, and intraoperative transfusion, with a statistically significant difference (p < 0.05). These findings are presented in Table 1. Table 1 Comparison of postoperative CMS in children with medulloblastoma(N=217) variable n (%) Mutism development ( n / %) c 2 p Yes No Gender -0.378 0.538 Male 151(69.6) 23 (15.2) 128 (84.8) Female 66 (30.4) 13 (19.7) 53 (80.3) Age（years） ≤5 67 (30.9) 17 (25.4) 50 (74.6) 5.979 0.050 5-10 106 (48.8) 15 (14.2) 91 (85.8) ＞10 44 (20.3) 4 (9.1) 40 (90.9) Maximum tumour diameter ≥5cm 0.280 0.597 Yes 79 (36.4) 15 (19.0) 64 (81.0) No 138 (63.6) 21 (15.2) 117 (84.8) Pathological typing 3.911 0.048 * Classic 137 (63.1) 17 (12.4) 120 (87.6) Atypical 80 (36.9) 19 (23.8) 61 (76.2) Whether it compresses the saddle area 0.043 0.836 Yes 5 (2.3) 1 (20.0) 4 (80.0) No 212 (97.7) 35 (16.5) 177 (83.5) ventricular hernia 0.871 0.351 Yes 34 (15.7) 8 (23.5) 26 (76.5) No 183 (84.3) 28 (15.3) 155 (84.7) Greater occipital foramen structural crowding 9.041 0.003 * Yes 56 (25.8) 17 (30.4) 39 (69.6) No 161 (74.2) 19 (11.8) 142 (88.2) Brainstem compression 0.149 0.699 Yes 38 (17.5) 5 (13.2) 33 (86.8) No 179 (82.5) 31 (17.3) 148 (82.7) Fourth ventricle infiltration 4.869 0.027 * Yes 195 (89.9) 36 (18.5) 159 (81.5) No 22 (10.1) 0 (0) 22 (100.0) Infiltrating supercerebellar earthworms 0.001 0.980 Yes 130 (59.9) 21 (16.2) 109 (83.8) No 87 (40.1) 15 (17.2) 72 (82.8) Continued Table 1 Comparison of postoperative CMS in children with medulloblastoma(N=217) variable n (%) Mutism development ( n / %) c 2 p Yes No Right cerebellum infiltration 0.237 0.626 Yes 25 (11.5) 5 (20.0) 20 (80.0) No 192 (88.5) 31 (16.1) 161 (83.9) Left cerebellum infiltration 0.237 0.626 Yes 25 (11.5) 5 (20.0) 20 (80.0) No 192 (88.5) 31 (16.1) 161 (83.9) Pontine brain infiltration 8.456 0.004 * Yes 10 (4.6) 5 (50.0) 5 (50.0) No 207 (95.4) 31 (15.0) 176 (85.0) Supratentorial hydrocephaly 5.575 0.018 * Yes 121 (55.8) 27 (22.3) 94 (77.7) No 96 (44.2) 9 (9.4) 87 (90.6) Left frontal infiltration 1.018 0.313 Yes 5 (2.3) 0 (0) 5 (100.0) No 212 (97.7) 36 (17.0) 176 (83.0) Numbers of symptoms ≤1 111 (51.2) 19 (17.1) 92 (82.9) 0.289 0.866 2 68 (31.3) 10 (14.7) 58 (85.3) ≥3 38 (17.5) 7 (18.4) 31 (81.6) Duration of operation（min） 4.608 0.100 ≤180 19 (8.8) 0 (0) 19 (100.0) 180-360 163 (75.1) 31 (19.0) 132 (81.0) ＞360 35 (16.1) 5 (14.3) 30 (85.7) Surgical bleeding（ml） 5.487 0.064 ≤100 81 (37.3) 9 (11.1) 72 (88.9) 100-200 78 (35.9) 19 (24.4) 59 (75.6) ＞200 58 (26.7) 8 (13.8) 50 (86.2) Blood transfusion during surgery 9.075 0.003 * Yes 104 (47.9) 26 (25.0) 78 (75.0) No 113 (52.1) 10 (8.8) 103 (91.2) Increased temperature three days after surgery 2.770 0.096 Yes 146 (67.3) 29 (19.9) 117 (80.1) No 71 (32.7) 7 (9.9) 64 (90.1) Post-operative central nervous system 2.448 0.118 Yes 92 (42.4) 20 (21.7) 72 (78.3) No 125 (57.6) 16 (12.8) 109 (87.2) Use mannitol post-operatively 0.898 0.343 Yes 145 (66.8) 27 (18.6) 118 (81.4) No 72 (33.2) 9 (12.5) 63 (87.5) Results of logistic regression analysis A logistic regression analysis was conducted on a cohort of children with medulloblastoma who exhibited CMS following surgical intervention for medulloblastoma. The dependent variable in the logistic regression analysis was the presence of CMS, while the independent variables were the statistically significant variables identified in the univariate analysis. The results demonstrated that three variables, namely tumour infiltration of the pontine brain, supratentorial hydrocephalus and the presence or absence of intraoperative blood transfusion, were incorporated into the regression equation. Additionally, the OR values for tumour infiltration of the pontine brain, supratentorial hydrocephalus and the presence or absence of intraoperative blood transfusion were calculated. These findings indicate that tumour infiltration of the pontine brain, supratentorial hydrocephalus and intraoperative blood transfusion are the risk factors for the development of cerebellar vermis syndrome in postoperative medulloblastoma children. Collectively, the three variables explained 12.3% of the total variance, as demonstrated in Table 2. Table 2 Logistic regression analysis of postoperative CMS( N =217) variable b Wald P OR 95% Confidence Interval upper lower constant -5.865 10.020 0.002 0.003 - - Pontine brain infiltration 2.126 8.242 0.004 * 8.383 1.963 35.792 Supratentorial hydrocephaly 0.916 4.266 0.039 * 2.500 1.048 5.962 Intraoperative blood transfusion 1.427 8.984 0.003 * 4.165 1.639 10.589 Discussion Higher incidence of CMS The available literature suggests that the pathogenesis of postoperative CMS in posterior cranial fossa tumours involves a multifactorial approach[10]. The occurrence of postoperative CMS in paediatric patients with medulloblastoma is two to three times more prevalent than in those with astrocytoma or ventricular meningioma at the same site. However, the underlying biological mechanism remains unclear [11, 12].The findings of Pitsika et al [13] indicated that the prevalence of CMS was 24% in children who had undergone surgery for medulloblastoma.Pols et al[9] investigated 71 cases of medulloblastoma in children, and 28 (35%) of these children developed CMS postoperatively. In the present study, the incidence of postoperative CMS in children with medulloblastoma was found to be 16.6%, which is slightly lower than the incidence reported in the literature, but still at a high level. The rationale behind this phenomenon may be attributed to the fact that medulloblastoma manifests in the midline of the posterior cranial fossa, predominantly situated in the superior cerebellar peduncle at the apex of the fourth ventricle. Surgical resection necessitates incision of the cerebellar peduncle, consequently impacting the dentate nucleus of the cerebellum [14]. The cerebellum is also implicated in certain cognitive and language processes[15]. Consequently, due to the particular location of the medulloblastoma, the incidence of postoperative CMS is relatively high. Analysis of risk factors for CMS Pontine brain infiltration The results of this study showed that tumour infiltration of the pontine brain was a risk factor for the development of CMS in children with medulloblastoma postoperatively (OR=8.383, p=0.004). Although medulloblastoma located in the cerebellopontine angle (CPA) is extremely rare [16], it can occur in children and adults. The ventral aspect of the cerebral pontine, known as the pontine basalis, is lined with a large number of transverse fibres connecting the cerebellar hemispheres, and when the tumour infiltrates the pontine, it usually manifests as increased intracranial pressure, cerebellar dysfunction as well as cranial nerve dysfunction [17]. More importantly, total resection of medulloblastoma in the cerebellar pontine angle carries an increased risk of injury to the facial nerve and adjacent important brain structures, which may increase the incidence of surgical complications, and children with medulloblastoma in the cerebellar pontine angle are generally susceptible to poor outcomes after surgery compared to adults [16]. Therefore, when medulloblastoma is located in the cerebellar pontine horn, children should be alerted to postoperative complications such as CMS. Supratentorial hydrocephaly The findings of this study indicate that supratentorial hydrocephalus represents a risk factor for the postoperative development of CMS in children with medulloblastoma (OR=2.500, P=0.039), a conclusion that is consistent with the observations of Schmidt et al. [18] and Yang et al. [19].The analysis of the reason may be due to medulloblastoma, which is typically located in the posterior cranial fossa. This is because the posterior cranial fossa is the point at which the cerebrospinal fluid circulation must pass through. The space is narrow, the compensatory capacity is limited, and as the tumour grows, it compresses the cerebrospinal fluid circulatory pathway. This can easily lead to the obstruction of the cerebrospinal fluid circulation, resulting in obstructive hydrocephalus[20]. The loss of compensation stage of hydrocephalus can manifest as a headache, vomiting, an altered level of consciousness and other symptoms indicative of increased intracranial pressure. In clinical practice, cerebrospinal fluid shunting is typically performed via a ventriculoperitoneal shunt or an endoscopic third ventricular floor fistula with the aim of alleviating the symptoms of intracranial hypertension. This approach effectively reduces the mechanical traction experienced during the subsequent tumour resection surgery and the morbidity rate of CMS to a certain degree [18].It is therefore recommended that children with medulloblastoma presenting with hydrocephalus undergo a ventriculoperitoneal shunt or endoscopic third ventricular floor fistula in a timely manner prior to tumour resection, depending on the individual child's condition. Intraoperative blood transfusion The results of this study showed that intraoperative blood transfusion was a risk factor for the postoperative development of cerebellar mute syndrome in children with medulloblastoma (OR=4.165, p=0.003). Similar findings were reported by Pols et al [9], who concluded that children with CMS had more intraoperative haemorrhagic events than children without CMS. Compared to adults, children have a smaller blood volume and are therefore more susceptible to hypovolemia, which means that even a relatively small amount of blood loss can compromise oxygen delivery to the surgical area and adjacent tissues and induce local ischaemia, such as in the cerebellopontine nucleus, increasing the likelihood that children with medulloblastoma will develop CMS postoperatively [21]. While the evidence for a link between blood transfusions during surgery and whether children with medulloblastoma develop CMS after surgery is less clear, the results of this trial showed that children with medulloblastoma that received blood transfusions during surgery had a 4-fold higher risk of developing CMS than children that did not receive blood transfusions during surgery; Therefore, while further large-sample multicentre studies are being conducted to improve the accuracy of the results, clinical healthcare professionals should be alert to children with medulloblastoma who have received blood transfusions intraoperatively. Therefore, clinical healthcare professionals should be alert to children with medulloblastoma who have received blood transfusions intraoperatively, identify the symptoms of CMS in a timely manner, and provide appropriate treatment and care as early as possible. Nursing Response to Speech Rehabilitation Assessment of language function Assessment of speech function in children with cerebellar mutism Studies have shown that the recovery process of CMS begins with gradual improvement of psychiatric symptoms and cerebellar hemispheric dyskinesia, disappearance of urinary retention, followed by an increase in patient feeding and gradual recovery of oropharyngeal muscle function, and finally recovery of speech function, with varying degrees of dysarthria remaining after resolution of CMS in the majority of children [22, 23].Therefore, timely and accurate implementation of language function assessment for children is important for prognostic rehabilitation. Since there are fewer studies on systematic language rehabilitation methods for children with postoperative cerebellar mute syndrome after medulloblastoma, the present study combines the clinical characteristics of children with CMS, risk factors, and previous literature [2, 10], and initially develops a nursing assessment method as follows: the assessment includes the cause, type, and degree of aphasia, as well as the ability of the child to listen, speak, read, and write.According to the children's responses, they were classified into three grades: (1) responsive, i.e. responding quickly to verbal elicitation, auditory stimulation and various expressive movements; (2) unresponsive, i.e. responding slowly to various elicitation and stimulation; and (3) unresponsive, i.e. unresponsive to all types of elicitation and stimulation. During the assessment, observe which method of stimulation the child is more sensitive and receptive to. Determine the mode of communication and the content and method of training for language expression according to the specific situation. Nursing Response to Speech Rehabilitation Nursing response to speech rehabilitation for children with cerebellar mutism According to the results of the speech assessment, the nurse in charge provided the children with post-operative speech training on a one-to-one basis, which included repetition of words and phrases, reading exercises and non-verbal communication training.① The first phase, according to the child's response, the child is directed to do oral exercises, tongue movement and pronunciation training; ② The second phase, repeat the word sentence training, such as good, bad, to be, don't want, but also the use of colourful pictures and familiar photographs to gradually do the dialogue of the longer sentence. The order of individual words, phrases, short phrase pronunciation, can also do appropriate prompts, such as "eat", the child will say "rice", and finally say the complete word "eat". In the third stage, reading practice is carried out, guiding the child to read big titles, magazines or favourite books to speed up the recovery of the speech function; ④ In the fourth stage, non-verbal communication training is carried out, and the psychological crisis intervention method of ABC is adopted for the child's nervousness and anxiety: A (psychological first aid to stabilise emotions), B (behavioural adjustment), C (cognitive correction), and physical contact with the child can be tried to make the child feel that the other party can understand his situation and psychological state. We can also try physical contact with the child to make them feel that the other person understands their situation and psychology, and we can play their favourite music for verbal stimulation. In the training process, pay attention to the voice from light to strong. In conclusion, the incidence of postoperative cerebellar silence syndrome in children with medulloblastoma is high. This study confirmed that tumour infiltration of the pontine brain, supratentorial hydrocephalus, and intraoperative blood transfusion are independent risk factors for the development of cerebellar silence in postoperative medulloblastoma children. In light of the findings of this study, it is recommended that the perioperative observation of children with medulloblastoma be reinforced, and that individualised rehabilitation training and targeted nursing interventions be provided in a timely manner in the event of cerebellar vermiform syndrome. Declarations Ethics approval and consent to participate This study was approved by the Medical Ethics Committee of Beijing Tiantan Hospital of Capital Medical University.（approval number KY2022-067-01） Consent for publication All patients gave their written informed consent for publication. Availability of data and materials The datasets used and analysed during the current study available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests Funding This study was financially supported by the Research Team Building Project of the Artificial Intelligence Research Institute of Hefei Comprehensive National Science Center (No. 21KT013-01). Authors' contributions Ruifang Zhu: Conceptualization, Methodology, Software, Formal analysis Writing −original draft. Tong Wang: Formal analysis, Validation. Huan Wang: Data collectionLiyun Zhong:Visualization,Software. 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Cerebellar Mutism Syndrome After Posterior Fossa Tumor Surgery in Children-A Retrospective Single-Center Study. World Neurosurg. 2023;173:e622-e628. doi:10.1016/j.wneu.2023.02.117 Yang W, Ge M, Zhu K, et al. Male Predisposition in Cerebellar Mutism Syndrome: a Cohort Study. Cerebellum. 2023;22(4):730-738. doi:10.1007/s12311-022-01449-6 DONG Kang, ZHONG Dong, YANG Jia, et al. Management of perioperative hydrocephalus in patients with posterior cranial fossa tumour combined with hydrocephalus[J]. Journal of Clinical Neurosurgery, 2021,18(05):552-556. Park YH, Lee JH, Song HG, Byon HJ, Kim HS, Kim JT. The accuracy of noninvasive hemoglobin monitoring using the radical-7 pulse CO-Oximeter in children undergoing neurosurgery. Anesth Analg. 2012;115(6):1302-1307. doi:10.1213/ANE.0b013e31826b7e38 Rong Hongtao, Yue Shuyuan, Hui Xuhui. Cerebellar mutism[J]. Chinese Journal of Neurosurgery, 2015,31(1). Tursun Meisuli, Zhu Guohua, Du Guojia, et al. Cerebellar silence and secondary dysarthria syndrome[J]. Chinese Journal of Neurosurgical Diseases, 2010,09(6). Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5082438","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":364492115,"identity":"1b47c765-9d8f-494b-9254-7371400685a0","order_by":0,"name":"ZHU Ruifang","email":"","orcid":"","institution":"Beijing Tian Tan Hospital","correspondingAuthor":false,"prefix":"","firstName":"ZHU","middleName":"","lastName":"Ruifang","suffix":""},{"id":364492118,"identity":"e2e09edb-1dc5-41a3-b2f2-42cb075f9c52","order_by":1,"name":"ZHONG Liyun","email":"","orcid":"","institution":"Beijing Tian Tan Hospital","correspondingAuthor":false,"prefix":"","firstName":"ZHONG","middleName":"","lastName":"Liyun","suffix":""},{"id":364492121,"identity":"f8aaab56-1b0c-419f-b5c2-cbd47b5fc5b8","order_by":2,"name":"WANG Tong","email":"","orcid":"","institution":"Beijing Tian Tan Hospital","correspondingAuthor":false,"prefix":"","firstName":"WANG","middleName":"","lastName":"Tong","suffix":""},{"id":364492123,"identity":"72aea636-a2bd-4c62-9ac8-59d09818cd93","order_by":3,"name":"Wang Huan","email":"","orcid":"","institution":"Beijing Tian Tan Hospital","correspondingAuthor":false,"prefix":"","firstName":"Wang","middleName":"","lastName":"Huan","suffix":""},{"id":364492125,"identity":"9798d5e2-0254-49d0-a4c1-1bbfbe6fca39","order_by":4,"name":"GONG Jian","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/0lEQVRIiWNgGAWjYLACCQMGBn725gMMCQwMPPz8DURqkew5lgDSIiM54wCRNhncyDEA0TYGDQn4Vcq79x5+YVFglyfZc+abxMMdDDwGDAcYP3zMwa3F8My5NAsJg+RifvbebRKJZxh4zJkbmCVnbsOjZUaOmYGEAXPizJ6zmw0S2xh4LBsOsDHzEtZSn7jhRs5jsBaDAwn4tchL5Bg/kDA4DNLC+IAoLQY8Z8yAgXwc6LBjhg8Sz0jwSM442IzXL/LtPcafJf5UJ/azNz84+HOHjT0/f/PBDx/x2XKAgU1aAsZjbJAAk7jVg2xpYGD++AGhBa/iUTAKRsEoGKEAAHnKVD8qGoz8AAAAAElFTkSuQmCC","orcid":"","institution":"Beijing Tian Tan Hospital","correspondingAuthor":true,"prefix":"","firstName":"GONG","middleName":"","lastName":"Jian","suffix":""}],"badges":[],"createdAt":"2024-09-13 08:59:53","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5082438/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5082438/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":75108241,"identity":"43509bf3-b14e-42ae-ae12-bc9f27161bef","added_by":"auto","created_at":"2025-01-30 14:54:05","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":937121,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5082438/v1/2ae54a22-d56b-40be-a88e-ba78badb2c6d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Analysis of risk factors and language rehabilitation nursing strategies for CMS after pediatric medulloblastoma surgery","fulltext":[{"header":"Background","content":"\u003cp\u003eCerebellar mutism syndrome (CMS) is a complex group of neurological and cognitive-psychological clinical signs and symptoms [1] and is a common complication after posterior fossa tumours with a prevalence of 8%-40% [2, 3], with the highest prevalence of 30%-39% [4-6]after medulloblastoma in children.The incubation period of CMS is typically 1-6 days and is distinguished by transient postoperative muteness, speech disturbance, and emotional lability. Other prevalent symptoms include hypotonia, oropharyngeal dysfunction, dysphagia, ataxia, dysarthria, cognitive dysfunction, and dysfunction of the bowel and bladder[2,3,7]. However, it is not uncommon for speech and language to fail to return to a state of normality, with other cognitive and motor deficits also persisting[7].\u003c/p\u003e\n\u003cp\u003eThere is no conclusive evidence regarding the risk factors for postoperative complications of CMS in children with tumours of the posterior cranial fossa.The existing literature suggests that brainstem invasion or compression by lesions, the nature of tumours in the posterior cranial fossa, hydrocephalus, and central nervous system infections may be risk factors for the development of CMS[8,9]. However, the results of previous studies on these same influencing factors are still inconsistent, and the sample sizes are relatively small[9]. Furthermore, the data from multiple studies included in the meta-analysis of CMS risk factors could not be extracted. Additionally, the results of the studies included in the meta-analysis have some bias[10]. There is still a gap in the studies of CMS in children with medulloblastoma after surgery in China.Furthermore,research has demonstrated that there is no established,evidence-based treatment for CMS speech disorders. Non-pharmacological interventions are of greater importance than pharmacological treatments [3]. Consequently, this study retrospectively examines the incidence and contributing factors of postoperative CMS in children with medulloblastoma and explores the nursing strategies for postoperative speech function rehabilitation of these children. The objective is to provide a foundation for the intervention and prevention of postoperative CMS in children with medulloblastoma.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe conducted a single-center, retrospective cohort study. This study was approved by the Medical Ethics Committee of Beijing Tiantan Hospital of Capital Medical University.（approval number KY2022-067-01）,all patients gave their written informed consent for publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eParticipants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA retrospective analysis was conducted on the occurrence of postoperative CMS in 217 children with medulloblastoma who underwent tumour resection at our hospital between April 2019 and March 2022. The cohort consisted of 151 males and 66 females with a mean age of 7.42\u0026plusmn;3.42 years. The inclusion criteria were as follows: Inclusion criteria: ①age \u0026le;18 years; ② complete preoperative head CT and MRI imaging data; ③postoperative pathological diagnosis of medulloblastoma; ④complete postoperative follow-up data; ⑤not combined with other diseases affecting children\u0026apos;s intelligence and language function. Exclusion criteria: ①combined with serious heart, brain, liver, kidney or gastrointestinal disease; ②incomplete clinical data; ③diagnosed with mental illness.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSurvey tools\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e①A self-designed questionnaire was employed, comprising demographic and disease-related information. Demographic data included sex and age; disease-related data included whether the maximum diameter of the tumour was \u0026ge;5 cm, pathological staging, whether the tumour infiltrated or compressed the saddle region, whether the anterior third ventricle was herniated, whether there was structural crowding of the greater occipital foramen, whether the tumour infiltrated or compressed the brainstem, and whether the tumour Infiltration of the fourth ventricle, supratentorial cerebellar vermis, right cerebellar hemisphere, left cerebellar hemisphere, pontine brain, and supratentorial hydrocephalus were also assessed. In addition, the following factors were considered: whether the tumour infiltrated the left frontal region, the number of post-operative symptoms (cognitive dysfunction, ataxia, dysarthria, apathy, emotional lability, anorexia, dysuria, etc.), the duration of the operation, the type of tumour, the location of the tumour, the location of the tumour on the brain stem, and the location of the tumour on the brain stem. Additionally, the following variables were considered: the duration of surgery, the amount of intraoperative bleeding, the amount of blood transfused during surgery, the amount of postoperative temperature rise on the third day after surgery, the amount of postoperative central nervous system infection, and the amount of postoperative mannitol used.②The objective of this study was to ascertain whether children with medulloblastoma who underwent surgery subsequently developed CMS (CMS). To this end, the Icelandic Delphi consensus was employed as a criterion, and the children were classified into two groups: the CMS group and the non-CMS group. The former was defined according to the medical records of the postoperative course.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA research team comprising a specialist neurosurgical nurse, a specialist rehabilitation nurse, the head nurse and a doctor was established on the ward with the objective of gathering data and completing questionnaires on paediatric patients with medulloblastoma. This entailed following the case from admission to discharge, consulting the electronic medical record system, the electronic imaging system, the nursing notes, the surgical notes, the anaesthesia notes and other relevant documentation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe statistical analyses were conducted using the statistical software package SPSS 25.0. Continuous data were described using mean \u0026plusmn; standard deviation or median and interquartile range, while categorical data were described using frequency and percentage (%). A chi-squared test was employed to ascertain any differences between the children\u0026apos;s demographic and disease-related information and the presence of CMS. Variables that were found to be significant in the univariate analysis were included in the regression analysis. Logistic regression was used to analyse the effect of demographic and disease-related information on the presence or absence of cerebellar vermis syndrome in children after surgery. The level of statistical significance was set at p \u0026lt; 0.05.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eOccurrence of CMS in children with medulloblastoma\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe incidence of postoperative cerebellar dysmorphic disorder in children with medulloblastoma was 16.6% (36/217). This was observed among children who underwent tumour resection between April 2019 and March 2022.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults of single factor analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe findings demonstrated that the incidence of postoperative CMS was higher in children with medulloblastoma with pathologic staging of atypical, obstructive structure of the occipital foramen, tumour invasion of the fourth ventricle, tumour invasion of the pons, supratentorial hydrocephalus, and intraoperative transfusion, with a statistically significant difference (p \u0026lt; 0.05). These findings are presented in Table 1.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1 Comparison of postoperative CMS in children with medulloblastoma(N=217)\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"532\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 152px;\"\u003e\n \u003cp\u003e\u003cstrong\u003evariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003en\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMutism development\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(\u003cem\u003en /\u003c/em\u003e%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ec\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 152px;\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e-0.378\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.538\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e151(69.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e23 (15.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e128 (84.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e66 (30.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e13 (19.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e53 (80.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003eAge（years）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e\u0026le;5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e67 (30.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e17 (25.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e50 (74.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e5.979\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.050\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e5-10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e106 (48.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e15 (14.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e91 (85.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e＞10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e44 (20.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e4 (9.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e40 (90.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003eMaximum tumour diameter \u0026ge;5cm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e0.280\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.597\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e79 (36.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e15 (19.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e64 (81.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e138 (63.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e21 (15.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e117 (84.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 152px;\"\u003e\n \u003cp\u003ePathological typing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e3.911\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.048\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 152px;\"\u003e\n \u003cp\u003eClassic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e137 (63.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e17 (12.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e120 (87.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 152px;\"\u003e\n \u003cp\u003eAtypical\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e80 (36.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e19 (23.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e61 (76.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 152px;\"\u003e\n \u003cp\u003eWhether it compresses the saddle area\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e0.043\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.836\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 152px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e5 (2.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e1 (20.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e4 (80.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 152px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e212 (97.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e35 (16.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e177 (83.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003eventricular hernia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e0.871\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.351\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 152px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e34\u0026nbsp;(15.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e8\u0026nbsp;(23.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e26\u0026nbsp;(76.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 152px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e183\u0026nbsp;(84.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e28\u0026nbsp;(15.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e155\u0026nbsp;(84.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 152px;\"\u003e\n \u003cp\u003eGreater occipital foramen structural crowding\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e9.041\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.003\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 152px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e56\u0026nbsp;(25.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e17\u0026nbsp;(30.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e39\u0026nbsp;(69.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 152px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e161\u0026nbsp;(74.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e19\u0026nbsp;(11.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e142\u0026nbsp;(88.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003eBrainstem compression\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e0.149\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.699\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 152px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e38\u0026nbsp;(17.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e5\u0026nbsp;(13.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e33\u0026nbsp;(86.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 152px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e179\u0026nbsp;(82.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e31\u0026nbsp;(17.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e148\u0026nbsp;(82.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003eFourth ventricle infiltration\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e4.869\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.027\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 152px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e195\u0026nbsp;(89.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e36\u0026nbsp;(18.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e159\u0026nbsp;(81.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 152px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e22\u0026nbsp;(10.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e0\u0026nbsp;(0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e22\u0026nbsp;(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003eInfiltrating supercerebellar earthworms\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.980\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 152px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e130\u0026nbsp;(59.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e21\u0026nbsp;(16.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e109\u0026nbsp;(83.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 152px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e87\u0026nbsp;(40.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e15\u0026nbsp;(17.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e72\u0026nbsp;(82.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eContinued Table 1 Comparison of postoperative CMS in children with medulloblastoma(N=217)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"532\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003evariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003en\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMutism development\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(\u003cem\u003en /\u003c/em\u003e%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ec\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003eRight cerebellum infiltration\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e0.237\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e0.626\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 154px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e25 (11.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e5 (20.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e20 (80.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 154px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e192 (88.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e31 (16.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e161 (83.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003eLeft\u0026nbsp;cerebellum infiltration\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e0.237\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e0.626\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 154px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e25 (11.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e5 (20.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e20 (80.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 154px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e192 (88.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e31 (16.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e161 (83.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003ePontine brain infiltration\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e8.456\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e0.004\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 154px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e10 (4.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e5 (50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e5 (50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 154px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e207 (95.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e31 (15.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e176 (85.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003eSupratentorial hydrocephaly\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e5.575\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e0.018\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 154px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e121 (55.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e27 (22.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e94 (77.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 154px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e96 (44.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e9 (9.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e87 (90.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003eLeft frontal infiltration\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e1.018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e0.313\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 154px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e5 (2.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e5\u0026nbsp;(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 154px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e212 (97.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e36 (17.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e176 (83.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003eNumbers of symptoms\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e\u0026le;1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e111 (51.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e19 (17.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e92 (82.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e0.289\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e0.866\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e68 (31.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e10 (14.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e58 (85.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e\u0026ge;3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e38 (17.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e7 (18.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e31 (81.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003eDuration of operation（min）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e4.608\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e0.100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e\u0026le;180\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e19 (8.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e19\u0026nbsp;(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e180-360\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e163 (75.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e31 (19.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e132\u0026nbsp;(81.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e＞360\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e35 (16.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e5 (14.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e30 (85.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003eSurgical bleeding（ml）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e5.487\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e0.064\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e\u0026le;100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e81\u0026nbsp;(37.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e9\u0026nbsp;(11.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e72\u0026nbsp;(88.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e100-200\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e78\u0026nbsp;(35.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e19\u0026nbsp;(24.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e59\u0026nbsp;(75.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e＞200\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e58\u0026nbsp;(26.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e8\u0026nbsp;(13.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e50\u0026nbsp;(86.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003eBlood transfusion during surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e9.075\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e0.003\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 154px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e104 (47.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e26 (25.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e78 (75.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 154px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e113 (52.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e10 (8.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e103 (91.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003eIncreased temperature three days after surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e2.770\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e0.096\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 154px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e146 (67.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e29 (19.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e117 (80.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 154px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e71 (32.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e7 (9.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e64 (90.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003ePost-operative central nervous system\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e2.448\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.118\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 154px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e92 (42.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e20 (21.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e72 (78.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 154px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e125 (57.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e16 (12.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e109 (87.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003eUse mannitol post-operatively\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.898\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.343\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 154px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e145 (66.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e27 (18.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e118 (81.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 154px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e72 (33.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e9 (12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e63 (87.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eResults of logistic regression analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA logistic regression analysis was conducted on a cohort of children with medulloblastoma who exhibited CMS following surgical intervention for medulloblastoma. The dependent variable in the logistic regression analysis was the presence of CMS, while the independent variables were the statistically significant variables identified in the univariate analysis. The results demonstrated that three variables, namely tumour infiltration of the pontine brain, supratentorial hydrocephalus and the presence or absence of intraoperative blood transfusion, were incorporated into the regression equation. Additionally, the OR values for tumour infiltration of the pontine brain, supratentorial hydrocephalus and the presence or absence of intraoperative blood transfusion were calculated. These findings indicate that tumour infiltration of the pontine brain, supratentorial hydrocephalus and intraoperative blood transfusion are the risk factors for the development of cerebellar vermis syndrome in postoperative medulloblastoma children. Collectively, the three variables explained 12.3% of the total variance, as demonstrated in Table 2.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2 Logistic regression analysis of postoperative CMS(\u003cem\u003eN\u003c/em\u003e=217)\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"577\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003evariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eb\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eWald\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eOR\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 159px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e95% Confidence Interval\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eupper\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003elower\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003econstant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e-5.865\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e10.020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003ePontine brain infiltration\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e2.126\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e8.242\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e0.004\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e8.383\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e1.963\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e35.792\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003eSupratentorial hydrocephaly\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.916\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e4.266\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e0.039\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e2.500\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e1.048\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e5.962\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003eIntraoperative blood transfusion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e1.427\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e8.984\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e0.003\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e4.165\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e1.639\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e10.589\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003e\u003cstrong\u003eHigher incidence of CMS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe available literature suggests that the pathogenesis of postoperative CMS in posterior cranial fossa tumours involves a multifactorial approach[10]. The occurrence of postoperative CMS in paediatric patients with medulloblastoma is two to three times more prevalent than in those with astrocytoma or ventricular meningioma at the same site. However, the underlying biological mechanism remains unclear [11, 12].The findings of Pitsika et al [13]\u003csup\u003e \u003c/sup\u003eindicated that the prevalence of CMS was 24% in children who had undergone surgery for medulloblastoma.Pols et al[9] investigated 71 cases of medulloblastoma in children, and 28 (35%) of these children developed CMS postoperatively. In the present study, the incidence of postoperative CMS in children with medulloblastoma was found to be 16.6%, which is slightly lower than the incidence reported in the literature, but still at a high level. The rationale behind this phenomenon may be attributed to the fact that medulloblastoma manifests in the midline of the posterior cranial fossa, predominantly situated in the superior cerebellar peduncle at the apex of the fourth ventricle. Surgical resection necessitates incision of the cerebellar peduncle, consequently impacting the dentate nucleus of the cerebellum [14]. The cerebellum is also implicated in certain cognitive and language processes[15]. Consequently, due to the particular location of the medulloblastoma, the incidence of postoperative CMS is relatively high.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAnalysis of risk factors for CMS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePontine brain infiltration \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe results of this study showed that tumour infiltration of the pontine brain was a risk factor for the development of CMS in children with medulloblastoma postoperatively (OR=8.383, p=0.004). Although medulloblastoma located in the cerebellopontine angle (CPA) is extremely rare [16], it can occur in children and adults. The ventral aspect of the cerebral pontine, known as the pontine basalis, is lined with a large number of transverse fibres connecting the cerebellar hemispheres, and when the tumour infiltrates the pontine, it usually manifests as increased intracranial pressure, cerebellar dysfunction as well as cranial nerve dysfunction [17]. More importantly, total resection of medulloblastoma in the cerebellar pontine angle carries an increased risk of injury to the facial nerve and adjacent important brain structures, which may increase the incidence of surgical complications, and children with medulloblastoma in the cerebellar pontine angle are generally susceptible to poor outcomes after surgery compared to adults [16]. Therefore, when medulloblastoma is located in the cerebellar pontine horn, children should be alerted to postoperative complications such as CMS.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSupratentorial hydrocephaly \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe findings of this study indicate that supratentorial hydrocephalus represents a risk factor for the postoperative development of CMS in children with medulloblastoma (OR=2.500, P=0.039), a conclusion that is consistent with the observations of Schmidt et al. [18] and Yang et al. [19].The analysis of the reason may be due to medulloblastoma, which is typically located in the posterior cranial fossa. This is because the posterior cranial fossa is the point at which the cerebrospinal fluid circulation must pass through. The space is narrow, the compensatory capacity is limited, and as the tumour grows, it compresses the cerebrospinal fluid circulatory pathway. This can easily lead to the obstruction of the cerebrospinal fluid circulation, resulting in obstructive hydrocephalus[20]. The loss of compensation stage of hydrocephalus can manifest as a headache, vomiting, an altered level of consciousness and other symptoms indicative of increased intracranial pressure. In clinical practice, cerebrospinal fluid shunting is typically performed via a ventriculoperitoneal shunt or an endoscopic third ventricular floor fistula with the aim of alleviating the symptoms of intracranial hypertension. This approach effectively reduces the mechanical traction experienced during the subsequent tumour resection surgery and the morbidity rate of CMS to a certain degree [18].It is therefore recommended that children with medulloblastoma presenting with hydrocephalus undergo a ventriculoperitoneal shunt or endoscopic third ventricular floor fistula in a timely manner prior to tumour resection, depending on the individual child\u0026apos;s condition.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIntraoperative blood transfusion \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe results of this study showed that intraoperative blood transfusion was a risk factor for the postoperative development of cerebellar mute syndrome in children with medulloblastoma (OR=4.165, p=0.003). Similar findings were reported by Pols et al [9], who concluded that children with CMS had more intraoperative haemorrhagic events than children without CMS. Compared to adults, children have a smaller blood volume and are therefore more susceptible to hypovolemia, which means that even a relatively small amount of blood loss can compromise oxygen delivery to the surgical area and adjacent tissues and induce local ischaemia, such as in the cerebellopontine nucleus, increasing the likelihood that children with medulloblastoma will develop CMS postoperatively [21]. While the evidence for a link between blood transfusions during surgery and whether children with medulloblastoma develop CMS after surgery is less clear, the results of this trial showed that children with medulloblastoma that received blood transfusions during surgery had a 4-fold higher risk of developing CMS than children that did not receive blood transfusions during surgery; Therefore, while further large-sample multicentre studies are being conducted to improve the accuracy of the results, clinical healthcare professionals should be alert to children with medulloblastoma who have received blood transfusions intraoperatively. Therefore, clinical healthcare professionals should be alert to children with medulloblastoma who have received blood transfusions intraoperatively, identify the symptoms of CMS in a timely manner, and provide appropriate treatment and care as early as possible.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNursing Response to Speech Rehabilitation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAssessment of language function\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAssessment of speech function in children with cerebellar mutism Studies have shown that the recovery process of CMS begins with gradual improvement of psychiatric symptoms and cerebellar hemispheric dyskinesia, disappearance of urinary retention, followed by an increase in patient feeding and gradual recovery of oropharyngeal muscle function, and finally recovery of speech function, with varying degrees of dysarthria remaining after resolution of CMS in the majority of children [22, 23].Therefore, timely and accurate implementation of language function assessment for children is important for prognostic rehabilitation. Since there are fewer studies on systematic language rehabilitation methods for children with postoperative cerebellar mute syndrome after medulloblastoma, the present study combines the clinical characteristics of children with CMS, risk factors, and previous literature [2, 10], and initially develops a nursing assessment method as follows: the assessment includes the cause, type, and degree of aphasia, as well as the ability of the child to listen, speak, read, and write.According to the children\u0026apos;s responses, they were classified into three grades: (1) responsive, i.e. responding quickly to verbal elicitation, auditory stimulation and various expressive movements; (2) unresponsive, i.e. responding slowly to various elicitation and stimulation; and (3) unresponsive, i.e. unresponsive to all types of elicitation and stimulation. During the assessment, observe which method of stimulation the child is more sensitive and receptive to. Determine the mode of communication and the content and method of training for language expression according to the specific situation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNursing Response to Speech Rehabilitation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNursing response to speech rehabilitation for children with cerebellar mutism According to the results of the speech assessment, the nurse in charge provided the children with post-operative speech training on a one-to-one basis, which included repetition of words and phrases, reading exercises and non-verbal communication training.① The first phase, according to the child\u0026apos;s response, the child is directed to do oral exercises, tongue movement and pronunciation training; ② The second phase, repeat the word sentence training, such as good, bad, to be, don\u0026apos;t want, but also the use of colourful pictures and familiar photographs to gradually do the dialogue of the longer sentence. The order of individual words, phrases, short phrase pronunciation, can also do appropriate prompts, such as \u0026quot;eat\u0026quot;, the child will say \u0026quot;rice\u0026quot;, and finally say the complete word \u0026quot;eat\u0026quot;. In the third stage, reading practice is carried out, guiding the child to read big titles, magazines or favourite books to speed up the recovery of the speech function; ④ In the fourth stage, non-verbal communication training is carried out, and the psychological crisis intervention method of ABC is adopted for the child\u0026apos;s nervousness and anxiety: A (psychological first aid to stabilise emotions), B (behavioural adjustment), C (cognitive correction), and physical contact with the child can be tried to make the child feel that the other party can understand his situation and psychological state. We can also try physical contact with the child to make them feel that the other person understands their situation and psychology, and we can play their favourite music for verbal stimulation. In the training process, pay attention to the voice from light to strong.\u003c/p\u003e\n\u003cp\u003eIn conclusion, the incidence of postoperative cerebellar silence syndrome in children with medulloblastoma is high. This study confirmed that tumour infiltration of the pontine brain, supratentorial hydrocephalus, and intraoperative blood transfusion are independent risk factors for the development of cerebellar silence in postoperative medulloblastoma children. In light of the findings of this study, it is recommended that the perioperative observation of children with medulloblastoma be reinforced, and that individualised rehabilitation training and targeted nursing interventions be provided in a timely manner in the event of cerebellar vermiform syndrome.\u003c/p\u003e"},{"header":"Declarations","content":"\u003col\u003e\n \u003cli\u003eEthics approval and consent to participate\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eThis study was approved by the Medical Ethics Committee of Beijing Tiantan Hospital of Capital Medical University.（approval number KY2022-067-01）\u003c/p\u003e\n\u003col start=\"2\"\u003e\n \u003cli\u003eConsent for publication\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eAll patients gave their written informed consent for publication.\u003c/p\u003e\n\u003col start=\"3\"\u003e\n \u003cli\u003eAvailability of data and materials\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eThe datasets used and analysed during the current study available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003col start=\"4\"\u003e\n \u003cli\u003eCompeting interests\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eThe authors declare that they have no competing interests\u003c/p\u003e\n\u003col start=\"5\"\u003e\n \u003cli\u003eFunding\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eThis study was financially supported by the Research Team Building Project of the Artificial Intelligence Research Institute of Hefei Comprehensive National Science Center (No. 21KT013-01).\u003c/p\u003e\n\u003col start=\"6\"\u003e\n \u003cli\u003eAuthors\u0026apos; contributions\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eRuifang Zhu: Conceptualization, Methodology, Software, Formal analysis Writing \u0026minus;original draft. Tong Wang: Formal analysis, Validation. Huan Wang: Data collectionLiyun Zhong:Visualization,Software. Jian Gong: Conceptualization, Methodology,Writing \u0026minus; review \u0026amp; editing, Supervision, Project administration. All authors approved the final manuscript.\u003c/p\u003e\n\u003col start=\"7\"\u003e\n \u003cli\u003eAcknowledgements\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003ewe are grateful to anonymous editor and reviewers for their contributions to our manuscripts, which greatly improvesthe quality of our manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cbr\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eCatsman-Berrevoets C, Patay Z. Cerebellar mutism syndrome.\u0026nbsp;Handb Clin Neurol. 2018;155:273-288. doi:10.1016/B978-0-444-64189-2.00018-4\u003c/li\u003e\n \u003cli\u003eCatsman-Berrevoets CE. Cerebellar mutism syndrome: cause and rehabilitation.\u0026nbsp;Curr Opin Neurol. 2017;30(2):133-139. doi:10.1097/WCO.0000000000000426\u003c/li\u003e\n \u003cli\u003eDONG Xiaojin, WANG Wenting, TONG Shuai. Progress in the mechanism of speech disorder and rehabilitation intervention in cerebellar verbal syndrome[J]. Chinese Journal of Rehabilitation Medicine, 2022,37(05):705-708.\u003c/li\u003e\n \u003cli\u003eGudrunardottir T, Sehested A, Juhler M, Schmiegelow K. Cerebellar mutism: review of the literature.\u0026nbsp;Childs Nerv Syst. 2011;27(3):355-363. doi:10.1007/s00381-010-1328-2\u003c/li\u003e\n \u003cli\u003eKorah MP, Esiashvili N, Mazewski CM, et al. Incidence, risks, and sequelae of posterior fossa syndrome in pediatric medulloblastoma.\u0026nbsp;Int J Radiat Oncol Biol Phys. 2010;77(1):106-112. doi:10.1016/j.ijrobp.2009.04.058\u003c/li\u003e\n \u003cli\u003eRobertson PL, Muraszko KM, Holmes EJ, et al. Incidence and severity of postoperative cerebellar mutism syndrome in children with medulloblastoma: a prospective study by the Children\u0026apos;s Oncology Group.\u0026nbsp;J Neurosurg. 2006;105(6 Suppl):444-451. doi:10.3171/ped.2006.105.6.444\u003c/li\u003e\n \u003cli\u003eGudrunardottir T, Morgan AT, Lux AL, et al. Consensus paper on post-operative pediatric cerebellar mutism syndrome: the Iceland Delphi results.\u0026nbsp;Childs Nerv Syst. 2016;32(7):1195-1203. doi:10.1007/s00381-016-3093-3\u003c/li\u003e\n \u003cli\u003evan Baarsen K, Kleinnijenhuis M, Konert T, van Cappellen van Walsum AM, Grotenhuis A. Tractography demonstrates dentate-rubro-thalamic tract disruption in an adult with cerebellar mutism.\u0026nbsp;Cerebellum. 2013;12(5):617-622. doi:10.1007/s12311-013-0473-z\u003c/li\u003e\n \u003cli\u003ePols SYCV, van Veelen MLC, Aarsen FK, Gonzalez Candel A, Catsman-Berrevoets CE. Risk factors for development of postoperative cerebellar mutism syndrome in children after medulloblastoma surgery.\u0026nbsp;J Neurosurg Pediatr. 2017;20(1):35-41. doi:10.3171/2017.2.PEDS16605\u003c/li\u003e\n \u003cli\u003ePettersson SD, Kitlinski M, Miękisiak G, Ali S, Krakowiak M, Szmuda T. Risk factors for postoperative cerebellar mutism syndrome in pediatric patients: a systematic review and meta-analysis.\u0026nbsp;J Neurosurg Pediatr. 2021;29(4):467-475. Published 2021 Dec 31. doi:10.3171/2021.11.PEDS21445\u003c/li\u003e\n \u003cli\u003eReed-Berendt R, Phillips B, Picton S, et al. Cause and outcome of cerebellar mutism: evidence from a systematic review.\u0026nbsp;Childs Nerv Syst. 2014;30(3):375-385. doi:10.1007/s00381-014-2356-0\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.\u0026nbsp;Cortex. 2010;46(7):933-946. doi:10.1016/j.cortex.2009.10.007\u003c/li\u003e\n \u003cli\u003ePitsika M, Tsitouras V. Cerebellar mutism.\u0026nbsp;J Neurosurg Pediatr. 2013;12(6):604-614. doi:10.3171/2013.8.PEDS13168\u003c/li\u003e\n \u003cli\u003eCHEN Lihua, SUN Kai, CHEN Wenjin, et al. Epidemiological characteristics and prognosis of medulloblastoma[J]. Chinese Journal of Brain Disease and Rehabilitation (Electronic version), 2020,10(04):239-243.\u003c/li\u003e\n \u003cli\u003eDe Smet HJ, Paquier P, Verhoeven J, Mari\u0026euml;n P. The cerebellum: its role in language and related cognitive and affective functions.\u0026nbsp;Brain Lang. 2013;127(3):334-342. doi:10.1016/j.bandl.2012.11.001\u003c/li\u003e\n \u003cli\u003eWu T, Qu PR, Zhang S, et al. The clinical treatment and outcome of cerebellopontine angle medulloblastoma: a retrospective study of 15 cases.\u0026nbsp;Sci Rep. 2020;10(1):9769. Published 2020 Jun 17. doi:10.1038/s41598-020-66585-7\u003c/li\u003e\n \u003cli\u003eJaiswal AK, Mahapatra AK, Sharma MC. Cerebellopointine angle medulloblastoma.\u0026nbsp;J Clin Neurosci. 2004;11(1):42-45. doi:10.1016/j.jocn.2003.02.005\u003c/li\u003e\n \u003cli\u003eSchmidt S, Kovacs E, Usta D, et al. Cerebellar Mutism Syndrome After Posterior Fossa Tumor Surgery in Children-A Retrospective Single-Center Study.\u0026nbsp;World Neurosurg. 2023;173:e622-e628. doi:10.1016/j.wneu.2023.02.117\u003c/li\u003e\n \u003cli\u003eYang W, Ge M, Zhu K, et al. Male Predisposition in Cerebellar Mutism Syndrome: a Cohort Study.\u0026nbsp;Cerebellum. 2023;22(4):730-738. doi:10.1007/s12311-022-01449-6\u003c/li\u003e\n \u003cli\u003eDONG Kang, ZHONG Dong, YANG Jia, et al. Management of perioperative hydrocephalus in patients with posterior cranial fossa tumour combined with hydrocephalus[J]. Journal of Clinical Neurosurgery, 2021,18(05):552-556.\u003c/li\u003e\n \u003cli\u003ePark YH, Lee JH, Song HG, Byon HJ, Kim HS, Kim JT. The accuracy of noninvasive hemoglobin monitoring using the radical-7 pulse CO-Oximeter in children undergoing neurosurgery.\u0026nbsp;Anesth Analg. 2012;115(6):1302-1307. doi:10.1213/ANE.0b013e31826b7e38\u003c/li\u003e\n \u003cli\u003eRong Hongtao, Yue Shuyuan, Hui Xuhui. Cerebellar mutism[J]. Chinese Journal of Neurosurgery, 2015,31(1).\u003c/li\u003e\n \u003cli\u003eTursun Meisuli, Zhu Guohua, Du Guojia, et al. Cerebellar silence and secondary dysarthria syndrome[J]. Chinese Journal of Neurosurgical Diseases, 2010,09(6).\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"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":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Medulloblastoma, CMS, Risk factors, Language rehabilitation, Nursing","lastPublishedDoi":"10.21203/rs.3.rs-5082438/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5082438/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective \u003c/strong\u003eTo investigate the occurrence of CMS in children with medulloblastoma after surgery and analyze its risk factors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e The clinical data of 217 children with medulloblastoma who underwent tumor resection in pediatric neurosurgery of comprehensive first- class hospital in Beijing from April 2019 to March 2022 were retrospectively analyzed. According to the consensus of Iceland Delphi, CMS was diagnosed. According to whether CMS occurred after surgery, they were divided into CMS group and non CMS group, Logistic regression analysis was used to identify the risk factors for CMS in children with medulloblastoma after surgery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e Out of 217 children with medulloblastoma, 36 developed CMS after surgery, with an incidence rate of 16.6%. The results of logistic regression analysis showed that tumor infiltration into the pons, supratentorial hydrocephalus, and intraoperative blood transfusion were risk factors for postoperative CMS in children with medulloblastoma.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e The incidence of CMS in children with medulloblastoma after surgery is relatively high. Tumor infiltration into the pons, supratentorial hydrocephalus, and intraoperative blood transfusion can diagnose the occurrence of CMS in children with medulloblastoma after surgery. Nursing staff should pay attention to the mutism symptoms of children with medulloblastoma after surgery, and implement early language rehabilitation nursing interventions.\u003c/p\u003e","manuscriptTitle":"Analysis of risk factors and language rehabilitation nursing strategies for CMS after pediatric medulloblastoma surgery","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-11-18 05:24:57","doi":"10.21203/rs.3.rs-5082438/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c20c26d1-3dd0-472c-a0a6-d7968f97c1d9","owner":[],"postedDate":"November 18th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-01-30T14:53:43+00:00","versionOfRecord":[],"versionCreatedAt":"2024-11-18 05:24:57","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5082438","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5082438","identity":"rs-5082438","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}