Speech and language outcomes and survivorship following surgery for paediaric posterior fossa tumours

Introduction The posterior fossa (PF), including the cerebellum and brain stem, is the most common location for childhood brain. Aside from its role in motor function, the cerebellum plays an important role in cognition including executive functioning, spatial cognition, personality, speech and language. Impairments in these processes, especially language, are linked with poorer academic achievement and QoL in PF tumour survivors. However, speech and language assessments are not routinely conducted pre-surgically in children with PF tumours. This pilot study investigated the rate of postsurgical cognitive deficits during the chronic recovery period in a retrospective cohort of children with PF tumour resections. This was done to establish the need for more specialized investigation into the risk factors associated with surgically induced cognitive deficits. Methods Using retrospective behavioural data, the current pilot study investigated the prevalence of cognitive deficits in 37 children (aged 5 to 14 years) with primary PF tumours. All children had completed the Woodcock Johnson III – (Australian adaption) tests of Cognitive Abilities. Scores were standardized and then grouped into categories using the published performance boundaries for the Australian population. Results Overall this population presented with a range of cognitive deficits. Most prevalent was a below average score on reading fluency (52/12 % scored below average/very low), calculation (57/18 % scored below average/very low), math fluency (68/20 % scored below average and very low) and passage comprehension (38/14 % scored below average/very low). Only on the auditory working memory subtest did the group not demonstrate any ‘very low’ performance, with just 10% scoring below average. On all subtests involving literacy and numeracy skills over a quarter of the group demonstrated a below average performance. Conclusion This data demonstrates a pattern of below average cognitive functioning in skills required for academic success, specifically language and numeracy skills, in over half of the group studied. In order to ascertain the extent to which these are surgically induced impairments, both pre- and post- surgical detailed assessments of these functions are indicated. This data has highlighted the need for targeted investigation of risk prediction and prevention for speech and language deficits after posterior fossa treatment.