# Long-Term Outcomes Associated With Posterior Fossa Syndrome in Survivors of Childhood Medulloblastoma

## TL;DR

This study shows that children who survive medulloblastoma and develop posterior fossa syndrome face lasting cognitive and physical challenges, highlighting the need for better surgical techniques and long-term support.

## Contribution

The study provides the first long-term evaluation of posterior fossa syndrome's impact on survivors of childhood medulloblastoma.

## Key findings

- Posterior fossa syndrome is linked to significant deficits in attention, processing speed, and cognitive flexibility.
- Survivors with posterior fossa syndrome are more likely to need help with daily tasks due to physical and cognitive impairments.
- The syndrome's effects persist despite recovery from acute symptoms, emphasizing the need for improved surgical and postoperative care.

## Abstract

What are the long-term outcomes associated with posterior fossa syndrome in survivors of childhood medulloblastoma?

In this cohort study of 158 survivors of medulloblastoma 5 or more years from diagnosis, 23% developed posterior fossa syndrome. Compared with participants without posterior fossa syndrome, those with posterior fossa syndrome had significant deficits in attention, processing speed, and cognitive flexibility, and physical function and were more likely to require assistance with routine needs.

This cohort study found that posterior fossa syndrome was associated with lasting neurocognitive and physical deficits in survivors of medulloblastoma, emphasizing the need for strategies to minimize surgical morbidity, continued interventions, and support in this high-risk population to improve outcomes among survivors.

This cohort study evaluates the long-term neurological, neurocognitive, social, and quality of life outcomes associated with posterior fossa syndrome among survivors of childhood medulloblastoma.

Posterior fossa syndrome is a debilitating surgical complication affecting communication, motor skills, mood, language, and working memory in children treated for posterior fossa tumors. Although many recover from acute symptoms, the lifetime impact of posterior fossa syndrome remains unknown.

To evaluate the long-term neurological, neurocognitive, social, and quality of life outcomes associated with posterior fossa syndrome among survivors of medulloblastoma.

This retrospective cohort study included survivors of childhood medulloblastoma diagnosed between 1985 and 2012, with more than 5 years from diagnosis. All participants were treated at a tertiary academic center. Data were analyzed from January 1, 2024, to December 1, 2025.

History of posterior fossa syndrome.

Outcomes of interest included neurocognitive functioning (attention, cognitive flexibility, and visuomotor speed), neurological outcomes (cerebellar dysfunction, cranial nerve disorders, dysarthria, headaches, movement disorders, paralytic disorders, peripheral motor or sensory neuropathy, and seizures), physical performance, and social functioning. Statistical analysis included Mann-Whitney U, χ2, or Fisher exact tests, with multivariable linear regression used to assess the associations of posterior fossa syndrome with outcomes while adjusting for confounders.

A total of 158 participants (median [range] age at assessment, 25 [11–44] years; 96 [60.8%] male) were assessed, including 37 (23%) who developed posterior fossa syndrome and 121 controls who did not, with no differences in age at diagnosis, radiation dose, or age at assessment a median (range) follow-up of 14.2 (7.8-33.1) years. In adjusted models, participants with posterior fossa syndrome performed worse than those without in focused attention (β = −1.04 [95% CI, −1.62 to −0.45]; P < .001), motor-processing speed (β = −0.62 [95% CI, −1.16 to −0.09]; P = .02), cognitive flexibility (β = −0.85 [95% CI, −1.44 to −0.27]; P = .005), visuomotor processing speed (β = −0.65 [95% CI, −0.97 to −0.33]; P < .001), and physical performance test scores (β = −3.65 [95% CI, −5.36 to −1.93]; P < .001). Participants with posterior fossa syndrome were also more likely to require assistance with routine daily needs (odds ratio, 8.00 [95% CI, 2.56 to 25.04]; P < .001).

In this long-term cohort study of survivors of medulloblastoma, individuals with history of posterior fossa syndrome exhibited persistent neurocognitive and physical deficits compared with those without history of posterior fossa syndrome. Despite resolution of acute postoperative symptoms, posterior fossa syndrome was associated with lasting impairment, underscoring the need for improved surgical approaches, continued surveillance, and tailored interventions to optimize functional outcomes.