ID #1146 Posterior Fossa Syndrome Documentation in Pediatric Medulloblastoma: A 20-Year Single-Center Analysis of Interdisciplinary Recognition and Reporting Delays

Background

Posterior fossa syndrome (PFS) is characterized by heterogeneous symptoms, duration, and outcomes. Early recognition is essential to support timely intervention and improved recovery.

Methods

We conducted a retrospective review of 50 pediatric patients with medulloblastoma treated at a single institution between 2005 and 2025. Perioperative documentation from the multidisciplinary care team was evaluated. PFS symptoms were retrospectively assessed using the Pediatric Physiatric Posterior Fossa Symptoms Scale (3PFSs) 1.

Results

The cohort included 31 males (61%) and 19 females, with a median age at diagnosis of 5.1 years. PFS occurred in 33% of patients(n = 17). Median time to symptom onset was 3.5 days postoperatively, with an average diagnostic delay of 2 days. Neurosurgery was the first to document PFS in 35% of cases (n = 6), followed by neurology (24%), oncology (18%), and critical care (12%). Two cases were documented by speech therapy or psychology, and two cases were never formally diagnosed. Only 28% of patients received a postoperative neurology consultation. The median 3PFSs score was 6. Common symptoms included feeding difficulties (82%), mood lability (65%), mutism and/or attention disorders (47%), weakness or hypotonia (30%), and ataxia, dysmetria or modified diet (18% each).

Conclusions

Recognition and documentation of PFS varied across specialties, contributing to diagnostic delays and missed cases. Standardized perioperative neurological assessments using validated tools may improve diagnostic consistency, promote earlier recognition, and support timely rehabilitation.

Reference:

1) Wu and Nimec; The pediatric Physiatric Posterior Fossa Symptoms scale; Neuro-Oncology 27(2), 508, 2025