Affective pain processing disrupted in children with posterior cerebellar tumor resection

Objective: Damage to the posterior cerebellum can cause affective deficits in patients. In adults, cerebellar infarcts result in thermal hyperalgesia and affect descending modulation of pain. This study evaluated the effect of resection of low-grade cerebellar tumors on pain processing in human children. Background: Acute cerebellar infarctions have been shown to lead to affective and cognitive deficits in pediatric patients. However, the consequences of cerebellar insult on pain processing are unknown. Recent evidence not only suggests that the cerebellum plays a role in affective processing, but it also demonstrates increased activity in this area when individuals experience experimental or clinical pain, particularly in the posterior cerebellum. Describing the impact of surgical intervention in this area during childhood is of particular importance, as it may alter sensory development into adulthood. Design/Methods: Twelve pediatric patients treated with surgery only for low-grade gliomas (8 females, 4 males; mean age = 13.8±5.6) and twelve matched controls (8 females, 4 males; mean age = 13.8±5.7) were evaluated using quantitative sensory testing and fMRI. Five patients had tumors localized to posterior cerebellar hemispheres, henceforth identified as Crus Patients. Results: Crus Patients had significantly lower pain tolerance to a cold pressor test than controls. No significant differences were detected between subject groups for heat and cold detection thresholds (HDT, CDT), and heat and cold pain thresholds (HPT, CPT). Crus Patients also showed significantly decreased fMRI responses to painful heat in anterior insula and anterior cingulate. These areas have been associated with pain affect. Conclusions: Damage to posterior cerebellar hemispheres disrupted affective pain processing and endogenous pain modulation, resulting in decreased pain tolerance to suprathreshold noxious stimuli. This suggests that surgical resection of this region in children may increase the risk of developing pain disorders. Disclosure: Dr. Silva has nothing to disclose. Dr. Rosner has nothing to disclose. Dr. Ullrich has nothing to disclose. Dr. Chordas has nothing to disclose. Dr. Manley has nothing to disclose. Dr. Moulton has nothing to disclose.