Cerebellar tumor location as a predictor of neurocognitive functioning among survivors of pediatric brain tumors

The literature has clearly demonstrated that the cerebellum serves as a major processing center in the brain for many complex functional pathways ranging from attention and learning to emotions and affect. Research is now emphasizing the importance of connectivity between the cerebellum and other brain regions, and has begun highlighting the need to understand the impact of damage to distinct regions on functional pathways throughout the brain. One particular type of cerebellar damage, caused by posterior fossa tumors, has received substantial attention in the medical and neuropsychological literature in recent years. Tumors of the posterior fossa, which includes the cerebellum and brain stem structures, account for over 15% of brain tumors in children. Due to advances in treatment, survival rates have increased dramatically for individuals with posterior fossa tumors, leading to a greater need for long-term medical and psychosocial care. Treatments for these tumors, including chemotherapy and cranial radiation, are known to produce long-term deficits in a variety of neurocognitive domains. These deficits are referred to as “neurocognitive late effects,” and can be seen as impaired performance in the areas of attention, memory, executive functioning, visual-spatial processing, and processing speed. Neurocognitive late effects can be especially pronounced in patients with localized cranial radiation, as is common with malignant brain tumors. Research has clearly shown that different regions of the cerebellum uniquely contribute to various neurocognitive functions. Additionally, much research has assessed the neurocognitive implications of posterior fossa tumors in children. However, little work has examined the unique relationship between specific tumor locations within the cerebellum and later neurocognitive outcomes. The purpose of this document is to propose a study to determine whether the particular location of tumors in the cerebellum can predict neurocognitive functioning in the domains of attention and executive functioning in children with these tumors.