There are no certain ways to prevent the post-operative pediatric CMS from developing. Pre-operative corticosteroids have been recommended to reduce peritumoral edema, which may decrease nausea and vomiting and improve appetite and neurological symptoms. Intra-operative electrophysiological monitoring of the lateral rectus and facial muscles may help when the surgeon is working near the 6th cranial nerve , and surgical access and technique seem to play an important role. Electrophysiological monitoring, the avoiding of vermian dissection in favor of a telovelar approach, as well as minimal use of retraction and ultrasonic aspiration at the Children's National Medical Center in Washington decreased the incidence of the syndrome from 39% to 13% over an 8 year period ; another institute similarly reported lower incidence after abandoning vermal split . Piecemeal removal as opposed to en block tumor removal has been advocated , as is avoiding damage to the right cerebellar hemisphere since it can be deleterious to cognitive functioning . Navigated intra-operatie ultrasonography dramatically reduced the incidence of the post-operative pediatric CMS at one center, reportedly due to less retraction force on the cerebellar nuclei, vermis and superior cerebellar peduncles, minimal damage to normal cerebellar tissue and less post-operative edema . As with all forms of surgery, the more experienced the surgeon is, the better. Further research is highly warranted, and a prospective multicenter study of surgical methods, medication and genetics is underway in the Nordic countries and the USA (see under Research - current studies).
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