Radiological Predictors for Dysphagia Outcome in Patients Following Posterior Fossa Tumor Surgery
Karsten Lachner, Jürgen Konczalla, Corinna Manß, Elena Harborth, Maximilian Rauch, Markus Czabanka, Elke Hattingen, Sriramya LapaImportance:
Dysphagia is frequently observed in patients with posterior fossa tumor (PFT). Surgery can cause either deterioration of or improvement in preexisting dysphagia. In this context, imaging findings might help in predicting postsurgical dysphagic outcomes.
Objective:
To identify radiological predictors for worsening or improvement in presurgical dysphagia, and for any new onset of postsurgical dysphagia, by analyzing the presurgical brain magnetic resonance imaging (pMRI).
Setting:
Tertiary referral hospital.
Participants:
Patients undergoing neurosurgical treatment for PFT.
Intervention:
Flexible endoscopic evaluation of swallowing, before and after surgery.
Main Outcome Measures:
pMRI findings (presence of affection of cranial nerves V, VII, IX, X, and XII, ventrocaudal pontine compression, olivary compression, hydrocephalus) associated with postsurgical dysphagia outcomes. Dysphagia severity was rated according to the Fiberoptic Endoscopic Dysphagia Severity Scale (FEDSS).
Results:
Forty-three patients (60.5% female, 51.5 ± 15.6 years) with PFT-surgery were included. Presurgical dysphagia rate increased from 72.1% (n = 31), with a median FEDSS of 1 (IQR 2 range 1-5), to 79.1% (n = 34). In 46.5% (n = 20) of the cases deterioration of presurgical dysphagia was observed with a median of 1 (IQR 3, range 1-6), while 8 subjects showed a new onset of dysphagia. In 23.3% (n = 10) of the patients, an improvement in presurgical dysphagia was observed. In 2 cases, dysphagia severity decreased from severe to mild. pMRI did not show a significant association with postsurgical dysphagic outcome.
Conclusions:
Morphological characteristics of the brain tumor prior to surgery are not associated with dysphagia outcome. Besides the small sample size limiting statistical analysis, one may postulate that pMRI findings alone might not suffice to predict dysphagia outcome in patients after PFT-surgery.
Relevance:
Our study provides insights into possible characteristics of the tumor in relation to dysphagia outcome. Future studies warrant a larger cohort, analysis of intraoperative factors, and findings from postsurgical MRI, to fully understand dysphagia outcome after PFT-surgery.