Does the surgical route matter in cerebellar mutism syndrome? Comparing transvermian and telovelar approaches for pediatric posterior fossa tumors.

INTRODUCTION: Children and adolescents undergoing surgery for posterior fossa brain tumors are at risk of developing cerebellar mutism syndrome (CMS). Mutism or reduced speech is a cardinal symptom; however, CMS is also characterized by motor, cognitive, and emotional difficulties that may persist as long-term sequelae. The potential association between vermian incision during tumor resection and an increased incidence of CMS remains a subject of debate in the literature. RESEARCH QUESTION: This review aimed to evaluate whether the telovelar approach is associated with a lower risk of CMS compared with the transvermian approach. MATERIAL AND METHODS: Original studies were identified through a structured literature search of the PubMed and EMBASE databases. Postoperative speech outcomes and surgical approaches were extracted, and a pooled odds ratio (OR) was estimated using a random-effects model. RESULTS: 16 studies (PS = 6, RS = 9, mixed PS/RS = 1) met the inclusion criteria, comprising a total of 1369 patients. A pooled estimate yielded an OR of 1.85 (95% CI: 0.95-3.59, p = 0.07). Subanalysis of prospective studies yielded a pooled OR of 1.10 (95% CI: 0.29-4.19) and did not alter the overall result. CONCLUSION: This review adds to the existing evidence on surgery-related risk factors for CMS. We found no significant difference in CMS risk between transvermian and telovelar approaches, indicating no clear advantage of either approach in preventing CMS.