Psychiatric and neurobehavioral effects of posterior fossa surgery: A literature review

Abstract

The posterior fossa, housing the brainstem and cerebellum, has traditionally been viewed as exclusively responsible for motor functions. However, recent literature has highlighted the profound cognitive and psychiatric implications of lesions and surgery in this area. This literature review analyses case studies, clinical series, and systematic reviews regarding post-surgical neuropsychiatric sequelae in the posterior fossa. Relevant studies on cerebellar mutism, cerebellar cognitive affective syndrome, and emotional lability were included. Posterior fossa pathology is associated with a wide spectrum of disorders. Posterior Fossa Syndrome (PFS) is a common pediatric complication, characterised by mutism and irritability. In adults, although rarer, subtle personality changes, executive dysfunction, and severe emotional lability caused by brainstem compression can occur. Pathophysiological mechanisms involve the disruption of cerebello-cerebral circuits (diaschisis). Recognising postoperative psychiatric complications is essential. Neuropsychological assessment should be routine in posterior fossa surgery to optimise patient recovery and quality of life. This review may serve as a structured framework for future prospective and statistical studies that systematically evaluate psychiatric and cognitive outcomes after posterior fossa surgery.