Functional outcomes after resection of middle frontal gyrus diffuse gliomas

2021 ◽  
pp. 1-8
Author(s):  
Ramin A. Morshed ◽  
Anthony T. Lee ◽  
Elaina J. Wang ◽  
Jacob S. Young ◽  
Soonmee Cha ◽  
...  
Keyword(s):  
Functional Outcomes ◽  
Middle Frontal Gyrus ◽  
Diffuse Glioma ◽  
Minimal Risk ◽  
Who Grade ◽  
Intraoperative Mapping ◽  
Diffuse Gliomas ◽  
The Mean ◽  
Dti Tractography ◽  
Subcortical Mapping

OBJECTIVE The clinical outcomes for patients undergoing resection of diffuse glioma within the middle frontal gyrus (MFG) are understudied. Anatomically, the MFG is richly interconnected to known language areas, and nearby subcortical fibers are at risk during resection. The goal of this study was to determine the functional outcomes and intraoperative mapping results related to resection of MFG gliomas. Additionally, the study aimed to evaluate if subcortical tract disruption on imaging correlated with functional outcomes. METHODS The authors performed a retrospective review of 39 patients with WHO grade II–IV diffuse gliomas restricted to only the MFG and underlying subcortical region that were treated with resection and had no prior treatment. Intraoperative mapping results and postoperative neurological deficits by discharge and 90 days were assessed. Diffusion tensor imaging (DTI) tractography was used to assess subcortical tract integrity on pre- and postoperative imaging. RESULTS The mean age of the cohort was 37.9 years at surgery, and the median follow-up was 5.1 years. The mean extent of resection was 98.9% for the cohort. Of the 39 tumors, 24 were left sided (61.5%). Thirty-six patients (92.3%) underwent intraoperative mapping, with 59% of patients undergoing an awake craniotomy. No patients had positive cortical mapping sites overlying the tumor, and 12 patients (33.3%) had positive subcortical stimulation sites. By discharge, 8 patients had language dysfunction, and 5 patients had mild weakness. By 90 days, 2 patients (5.1%) had persistent mild hand weakness only. There were no persistent language deficits by 90 days. On univariate analysis, preoperative tumor size (p = 0.0001), positive subcortical mapping (p = 0.03), preoperative tumor invasion of neighboring subcortical tracts on DTI tractography (p = 0.0003), and resection cavity interruption of subcortical tracts on DTI tractography (p < 0.0001) were associated with an increased risk of having a postoperative deficit by discharge. There were no instances of complete subcortical tract transections in the cohort. CONCLUSIONS MFG diffuse gliomas may undergo extensive resection with minimal risk for long-term morbidity. Partial subcortical tract interruption may lead to transient but not permanent deficits. Subcortical mapping is essential to reduce permanent morbidity during resection of MFG tumors by avoiding complete transection of critical subcortical tracts.

scholarly journals NI-10 Reclassification of diffuse gliomas based on molecular diagnosis -evaluation of methionine uptake and treatment outcome-

2021 ◽  
Vol 3 (Supplement_6) ◽  
pp. vi19-vi19
Author(s):  
Kaoru Tamura ◽  
Motoki Inaji ◽  
Daisuke Kobayashi ◽  
Shoko Hara ◽  
Jun Karakama ◽  
...  
Keyword(s):  
Molecular Diagnosis ◽  
Standardized Uptake Value ◽  
Genetic Alterations ◽  
Normal Brain ◽  
Diffuse Glioma ◽  
Who Grade ◽  
Oligodendroglial Tumors ◽  
Methionine Uptake ◽  
Diffuse Gliomas ◽  
The Mean

Abstract Object: The revised 2016 WHO Classification of Tumours of the Central Nervous System incorporates genetic alterations into the classification system, with the goal of creating more homogenous disease categories with greater prognostic value. In this study, we reclassified diffuse gliomas with molecular diagnosis and examined for 11C-methionine uptake and prognosis. Methods. 182 diffuse glioma patients (Grade II in 42 patients, Grade III in 61 patients, Grade IV in 77 patients) treated at Tokyo Medical and Dental University Hospital from 2000 to 2018 were included in this study. The IDH1/2, ATRX and 1p19q status were analyzed using tumor samples. The tumor-to-normal ratio (T/N) of 11 C-methionine uptake was calculated by dividing the mean standardized uptake value (SUV) for the tumor by the mean SUV of the normal brain. Result. By molecular diagnosis, 11 diffuse astrocytomas and 17 anaplastic astrocytomas were diagnosed as “IDH-mutant”, while 14 diffuse astrocytomas and 29 anaplastic astrocytomas were diagnosed as “IDH-wild”. 5 out of 77 grade IV tumors had IDH mutation. 4 tumors were diagnosed as “Diffuse midline glioma, H3 K27M-mutant”. In the 32 oligodendroglial tumors, 12 oligodendrogliomas and 9 anaplastic oligodendrogliomas were diagnosed as “IDH-mutant and 1p/19q-codeleted”. The median T/N ratios in oligodendroglial tumors with “IDH-mutant and 1p/19q-codeleted” were significantly higher than those in astrocytic tumors with “IDH-mutant”. On the other hand, in tumors with the same genetic background, higher grade tumor has significant higher T/N ratio. Kaplan-Meier survival analysis revealed that oligodendroglial tumors with “IDH-mutant and 1p/19q-codeleted” had significantly better outcomes regardless of WHO grade. Overall survival was 90.9% at 5 years and 77.9% at 10 years in oligodendroglial tumors with “IDH-mutant and 1p/19q-codeleted”. IDH wild tumors had significantly worse outcomes.Conclusions. The results indicated that diffuse glioma categories reclassified with molecular classification correlate with the T/N ratio of methionine and the prognosis.

NCOG-25. REVISITING THE PIGNATTI RISK SCORE IN LOW-GRADE GLIOMA PATIENTS IN THE MOLECULAR ERA

2021 ◽  
Vol 23 (Supplement_6) ◽  
pp. vi157-vi157
Author(s):  
Christine Jungk ◽  
Mara Gluszak ◽  
Philip Dao Trong ◽  
Andreas von Deimling ◽  
Christel Herold-Mende ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Risk Score ◽  
Low Grade ◽  
Tumor Diameter ◽  
Diffuse Glioma ◽  
Who Grade ◽  
Cox Regression Analysis ◽  
Diffuse Gliomas ◽  
The Individual

Abstract Until now, the Pignatti risk score has been used to guide treatment decisions after histological diagnosis of diffuse glioma WHO grade 2. However, its prognostic value was derived from a historic cohort that has been diagnosed by morphologic rather than molecular criteria. We re-challenged the Pignatti score in a contemporary, molecularly characterized cohort. From our institutional cohort of 422 diffuse gliomas WHO grade 2, 202 patients were identified for whom IDH mutation status was known and 1p/19q co-deletion or loss of ATRX expression unambiguously classified tumors into astrocytoma or oligodendroglioma. Patients with IDH wildtype astrocytoma (n=9), multifocal lesions or brainstem involvement were excluded. Potential prognostic factors including the individual items of the Pignatti score (astrocytoma; age ≥40 years; neurologic deficit; maximum tumor diameter ≥6cm; tumor crossing midline) were correlated with progression-free survival (PFS) by univariate log-rank und multivariate Cox regression analysis. 165 patients with astrocytoma or oligodendroglioma were analysed of whom 109 (66%) did not receive adjuvant radio- or chemotherapy. 94 untreated patients with a minimum follow-up of 24 months entered survival analysis. These patients were classified as “high-risk” (Pignatti 3-5) and “low-risk” (Pignatti 0-2) in 15% and 85% and did not differ with regard to potential prognostic factors (gender; resection vs. biopsy; tumor recurrence) other than the individual Pignatti score items. Diameter ≥6 cm (p=0.006; HR=2.18) and midline crossing (p=0.003; HR=3.54) were identified as independent prognostic factors of PFS. Noteworthy, prognostic factors coincided when all patients (n=144) with a minimum follow-up of 24 months, regardless of adjuvant treatment, were analysed. In IDH mutant, molecularly characterized diffuse gliomas WHO grade 2, the Pignatti risk score as a whole no longer seems to be of prognostic relevance. Instead, outcome seems to be determined by tumor burden.

scholarly journals NIMG-32. THE PREDICTIVE CAPACITY OF PRE-OPERATIVE IMAGING ANALYSIS IN DIFFUSE GLIOMA: A COMPARISON OF CONNECTOMICS, RADIOMICS, AND CLINICAL PREDICTIVE MODELS

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii154-ii155
Author(s):  
Rebecca Harrison ◽  
Bryce Wei Quan Tan ◽  
Hong Qi Tan ◽  
Lloyd Tan ◽  
Mei Chin Lim ◽  
...  
Keyword(s):  
Model Building ◽  
Gray Matter Volume ◽  
Brain Mri ◽  
Cox Proportional Hazards ◽  
Interaction Matrix ◽  
Diffuse Glioma ◽  
Who Grade ◽  
Clinical Model ◽  
Clinical Variables ◽  
The Mean

Abstract BACKGROUND Radiomics and connectome analysis are distinct and non-invasive methods of deriving biologic information from MRI. Radiomics analyzes features intrinsic to the tumor, and connectomics incorporates data regarding the tumor and surrounding neural circuitry. In this study we used both techniques to predict glioma survival. METHODS We retrospectively identified 305 adult patients with histopathologically confirmed WHO grade II–IV gliomas who had presurgical, 3D, T1-weighted brain MRI. Available clinical variables included tumor lobe, hemisphere, multifocal nature grade, histology extent of surgical resection, patient age gender. For connectomics, we calculated nodal efficiencies, network size and degree for all pairs of 33 voxel cubes spanning the entire gray matter volume using similarity-based extraction and graph theory. Radiomic features were extracted using Pyradiomics and subjected to patient-level and population-level clustering (N=172). These clusters were then used to construct a multi-regional spatial interaction matrix for model building. Cox proportional hazards models were fit for clinical variables alone, connectomics alone, radiomics alone, connectomics+clinical and radiomics+clinical. We implemented 10-folds cross-validation and examined the mean area under the curve (AUC) across validation loops. RESULTS Median survival time was 134.2 months. The mean AUC for the clinical model was 0.79 +/- 0.01, the connectome model was 0.88 +/- 0.01, the combined connectome + clinical model was 0.93 +/- 0.01, the radiomic model was 0.64 +/- 0.05 and the radiomics+clinical model was 0.89+/-0.03. Radiomic analysis of the entire dataset as well as comparisons of radiomic+connectomics +/- clinical models are pending. CONCLUSIONS The combination of clinical variables and connectome analysis provided a more robust predictive model than other models. This suggests that connectome analysis incorporates valuable clinically-predictive information which can augment our capacity for prognostication of patients with diffuse glioma. These methods warrant further evaluation in larger prospective study of patients with diffuse glioma.

scholarly journals NGMA-1. Quantification of IDH mutant alleles predicts outcome in diffuse gliomas

2021 ◽  
Vol 3 (Supplement_2) ◽  
pp. ii4-ii4
Author(s):  
Mathew Voisin ◽  
Gelareh Zadeh
Keyword(s):  
Overall Survival ◽  
Progression Free Survival ◽  
Absolute Quantification ◽  
Specific Method ◽  
Diffuse Glioma ◽  
Who Grade ◽  
Initial Surgery ◽  
Highly Sensitive ◽  
Idh Mutations ◽  
Diffuse Gliomas

Abstract Background IDH mutation is the main factor used in the prognostication of diffuse gliomas, however within IDH mutated gliomas there still remains a high variability in both tumor progression and overall survival.1 Digital droplet polymerase chain reaction (ddPCR) is one of the latest molecular amplification techniques that offers high precision in addition to the ability of absolute quantification of mutant allele copies.2 Methods A total of 102 IDH mutant diffuse glioma tumor samples ranging from WHO grade 2 to 4 were collected. This cohort includes a total of 45 paired samples collected at two distinct surgical timepoints: initial and recurrent. All samples underwent DNA extraction. A total of 5 ng of tumor DNA from each sample was analyzed using ddPCR for the detection and quantification of IDH1 R132H mutant alleles. Sanger sequencing was performed on all samples as a gold standard. Results ddPCR was highly sensitive (100%) and specific (99%) for the detection of IDH mutations. Initial tumor samples with a high number of IDH mutant copies split by median demonstrated decreased overall survival (p = 0.04) and shorter progression free survival (p = 0.024). The number of IDH mutant copies was independent of WHO grade (p = 0.6) and 1p19q codeletion status (p = 0.86). Tumor pairs that had IDH mutant copies increase at recurrence were trending but not significantly related to a decrease in remaining survival (p = 0.1). Conclusions ddPCR is a highly sensitive and specific method of detecting IDH mutations in diffuse gliomas. The number of IDH mutant copies in tumors at initial surgery can serve as an independent prognostic factor to help guide future treatment and follow-up.

scholarly journals Prognostic value of preoperative inflammatory markers in patients with different molecular subgroups of WHO grade II and III diffuse gliomas

2019 ◽  
Author(s):  
Zengxin Qi ◽  
Jiajun Cai ◽  
Xiangda Meng ◽  
Shengyong Cai ◽  
Chao Tang ◽  
...  
Keyword(s):  
Prognostic Marker ◽  
Diffuse Glioma ◽  
Wild Type ◽  
Molecular Subgroups ◽  
Who Grade ◽  
Independent Prognostic Marker ◽  
1P19q Codeletion ◽  
Diffuse Gliomas ◽  
Grade Ii

Abstract Background: To determine the prognostic implications of these immune indices in WHO Grade II & III gliomas and different molecular subgroups. Methods: Clinical data from 214 newly diagnosed WHO grade II and III diffuse glioma patients were studied retrospectively. Cut-off values were determined by X-tile software. IDH and TERT promotor mutations were detected by gene sequencing, and 1p19q codeletion was estimated via fluorescence in situ hybridization. Results: NLR was verified to be an independent prognostic marker for OS in WHO grade II and III diffuse gliomas. NLR level was also associated with OS of IDH mutant subgroup, TERT promotor mutant subgroup, 1p19q intact subgroup and with PFS of 1p19q intact subgroup. LMR level was associated with OS of WHO grade II and III diffuse gliomas and TERT promotor mutant subgroup. dNLR was verified to be an independent prognostic marker for OS in TERT promotor wild-type subgroup, 1p19q intact subgroup, IDH mutant TERT promotor wild-type 1p19q intact subgroup and for PFS of 1p19q intact subgroup. dNLR was associated with OS of WHO grade II and III diffuse gliomas and IDH mutant subgroup. 1p19q codeletion was correlated with low NLR.Conclusion: Preoperative NLR, LMR and dNLR levels were helpful to forecast prognosis in patients with WHO grade II and III gliomas and different genetic phenotypes.

scholarly journals Cognitive impairments are independently associated with shorter survival in diffuse glioma patients

2020 ◽  
Author(s):  
Emma van Kessel ◽  
Irene M. C. Huenges Wajer ◽  
Carla Ruis ◽  
Tatjana Seute ◽  
Susanne Fonville ◽  
...  
Keyword(s):  
Executive Functioning ◽  
Cognitive Functioning ◽  
Neuropsychological Assessment ◽  
Cognitive Impairments ◽  
Awake Surgery ◽  
Diffuse Glioma ◽  
Who Grade ◽  
Diffuse Infiltration ◽  
Domain Specific ◽  
Diffuse Gliomas

Abstract Background Diffuse gliomas (WHO grade II–IV) are progressive primary brain tumors with great variability in prognosis. Cognitive deficits are of important prognostic value for survival in diffuse gliomas. Until now, few studies focused on domain-specific neuropsychological assessment and rather used MMSE as a measure for cognitive functioning. Additionally, these studies did not take WHO 2016 diagnosis into account. We performed a retrospective cohort study with the aim to investigate the independent relationship between cognitive functioning and survival in treatment-naive patients undergoing awake surgery for a diffuse glioma. Methods In patients undergoing awake craniotomy between 2010 and 2017, we performed pre-operative neuropsychological assessments in five cognitive domains, with special attention for the domains executive functioning and memory. We evaluated the independent relation between these domains and survival, in a Cox proportional hazards model that included state-of-the-art integrated histomolecular (‘layered’ or WHO-2016) classification of the gliomas and other known prognostic factors. Results We included 197 patients. Cognitive impairments (Z-values ≦ − 2.0) were most frequent in the domains memory (18.3%) and executive functioning (25.9%). Impairments in executive functioning and memory were significantly correlated with survival, even after correcting for the possible confounders. Analyses with the domains language, psychomotor speed, and visuospatial functioning yielded no significant results. Extensive domain-specific neuropsychological assessment was more strongly correlated to survival than MMSE. Conclusion Cognitive functioning is independently related to survival in diffuse glioma patients. Possible mechanisms underlying this relationship include the notion of cognitive functioning as a marker for diffuse infiltration of the tumor and the option that cognitive functioning and survival are determined by overlapping genetic pathways and biomarkers.

scholarly journals Diagnostic value of microvessel structure in brain glial tumors

2017 ◽  
Vol 25 (3) ◽  
pp. 350-361 ◽  
Author(s):  
I. S. Shpon’ka ◽  
T. V. Shynkarenko
Keyword(s):  
Prognostic Significance ◽  
Diagnostic Value ◽  
Proliferation Index ◽  
Ki 67 ◽  
Who Grade ◽  
Vascular Area ◽  
Diffuse Gliomas ◽  
The Mean ◽  
Brain Gliomas ◽  
Diffuse Brain

Diffuse gliomas are the most common primary brain tumors with a disproportionately high mortality rate. Characteristics of microvessels are of high diagnostic and prognostic significance, however, the results of previous studies are controversial. The aim of the work is to evaluate the features of angiogenesis in diffuse gliomas on the basis of determining the qualitative and quantitative microvascular characteristics. Also important is their relationship with the histological type of tumor. Microvascular density (μm-1), total vascular area (%), total lumen area (%) and the mean diameter of microvessels (μm) were measured and calculated in diffuse brain gliomas (n=76) using GFAP-negative status of endothelium in the presence of exclusively GFAP-positive tumor cells. Proliferation of microvessels was evaluated using proliferation index of vascular epithelium (Ki-67). The possibility of routine evaluation of the angiogenesis in diffuse gliomas using GFAP and Ki-67 markers was defined. We revealed significant correlation between features of the neoplastic microvasculature and WHO Grade.

scholarly journals Prognostic value of preoperative inflammatory markers in patients with different molecular subgroups of WHO grade II and III diffuse gliomas

2019 ◽  
Author(s):  
Zengxin Qi ◽  
Jiajun Cai ◽  
Xiangda Meng ◽  
Shengyong Cai ◽  
Chao Tang ◽  
...  
Keyword(s):  
Prognostic Marker ◽  
Diffuse Glioma ◽  
Newly Diagnosed ◽  
Wild Type ◽  
Who Grade ◽  
Independent Prognostic Marker ◽  
Diffuse Gliomas ◽  
Grade Ii ◽  
Prognostic Implications

Abstract Objective: To determine the prognostic implications of these immune indices in WHO Grade II & III gliomas and different molecular subgroups.Methods : Clinical data from 214 newly diagnosed WHO grade II and III diffuse glioma patients were studied retrospectively. Cut-off values were determined by X-tile software. IDH and TERT promotor mutations were detected by gene sequencing, and 1p19q co-deletion was estimated via fluorescence in situ hybridization.Results: NLR was verified to be an independent prognostic marker for OS in WHO grade II and III diffuse gliomas. NLR level was also associated with OS of IDH mutant subgroup, TERT promotor mutant subgroup, 1p19q intact subgroup and with PFS of 1p19q intact subgroup. LMR level was associated with OS of WHO grade II and III diffuse gliomas and TERT promotor mutant subgroup. dNLR was verified to be an independent prognostic marker for OS in TERT promotor wild-type subgroup, 1p19q intact subgroup, IDH mutant TERT promotor wild-type 1p19q intact subgroup and for PFS of 1p19q intact subgroup. dNLR was associated with OS of WHO grade II and III diffuse gliomas and IDH mutant subgroup. 1p19q co-deletion was correlated with low NLR. Conclusion: Preoperative NLR, LMR and dNLR levels were helpful to forecast prognosis in patients with WHO grade II and III gliomas and different genetic phenotypes.

Analysis of human acellular nerve allograft combined with contralateral C7 nerve root transfer for restoration of shoulder abduction and elbow flexion in brachial plexus injury: a mean 4-year follow-up

2020 ◽  
Vol 132 (6) ◽  
pp. 1914-1924 ◽  
Author(s):  
Liang Li ◽  
Jiantao Yang ◽  
Bengang Qin ◽  
Honggang Wang ◽  
Yi Yang ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Nerve Root ◽  
Functional Outcomes ◽  
Elbow Flexion ◽  
Shoulder Abduction ◽  
Allograft Reconstruction ◽  
Acellular Nerve Allograft ◽  
The Mean ◽  
Monofilament Test

OBJECTIVEHuman acellular nerve allograft applications have increased in clinical practice, but no studies have quantified their influence on reconstruction outcomes for high-level, greater, and mixed nerves, especially the brachial plexus. The authors investigated the functional outcomes of human acellular nerve allograft reconstruction for nerve gaps in patients with brachial plexus injury (BPI) undergoing contralateral C7 (CC7) nerve root transfer to innervate the upper trunk, and they determined the independent predictors of recovery in shoulder abduction and elbow flexion.METHODSForty-five patients with partial or total BPI were eligible for this retrospective study after CC7 nerve root transfer to the upper trunk using human acellular nerve allografts. Deltoid and biceps muscle strength, degree of shoulder abduction and elbow flexion, Semmes-Weinstein monofilament test, and static two-point discrimination (S2PD) were examined according to the modified British Medical Research Council (mBMRC) scoring system, and disabilities of the arm, shoulder, and hand (DASH) were scored to establish the function of the affected upper limb. Meaningful recovery was defined as grades of M3–M5 or S3–S4 based on the scoring system. Subgroup analysis and univariate and multivariate logistic regression analyses were conducted to identify predictors of human acellular nerve allograft reconstruction.RESULTSThe mean follow-up duration and the mean human acellular nerve allograft length were 48.1 ± 10.1 months and 30.9 ± 5.9 mm, respectively. Deltoid and biceps muscle strength was grade M4 or M3 in 71.1% and 60.0% of patients. Patients in the following groups achieved a higher rate of meaningful recovery in deltoid and biceps strength, as well as lower DASH scores (p < 0.01): age < 20 years and age 20–29 years; allograft lengths ≤ 30 mm; and patients in whom the interval between injury and surgery was < 90 days. The meaningful sensory recovery rate was approximately 70% in the Semmes-Weinstein monofilament test and S2PD. According to univariate and multivariate logistic regression analyses, age, interval between injury and surgery, and allograft length significantly influenced functional outcomes.CONCLUSIONSHuman acellular nerve allografts offered safe reconstruction for 20- to 50-mm nerve gaps in procedures for CC7 nerve root transfer to repair the upper trunk after BPI. The group in which allograft lengths were ≤ 30 mm achieved better functional outcome than others, and the recommended length of allograft in this procedure was less than 30 mm. Age, interval between injury and surgery, and allograft length were independent predictors of functional outcomes after human acellular nerve allograft reconstruction.

Long-term outcomes of lumbar microdiscectomy in the pediatric population: a large single-institution case series

2019 ◽  
Vol 24 (5) ◽  
pp. 549-557
Author(s):  
Malia McAvoy ◽  
Heather J. McCrea ◽  
Vamsidhar Chavakula ◽  
Hoon Choi ◽  
Wenya Linda Bi ◽  
...  
Keyword(s):  
Conservative Management ◽  
Functional Outcomes ◽  
Pediatric Patients ◽  
Clinical Presentation ◽  
Case Series ◽  
Csf Leak ◽  
Single Institution ◽  
The Mean

OBJECTIVEFew studies describe long-term functional outcomes of pediatric patients who have undergone lumbar microdiscectomy (LMD) because of the rarity of pediatric disc herniation and the short follow-up periods. The authors analyzed risk factors, clinical presentation, complications, and functional outcomes of a single-institution series of LMD patients over a 19-year period.METHODSA retrospective case series was conducted of pediatric LMD patients at a large pediatric academic hospital from 1998 to 2017. The authors examined premorbid risk factors, clinical presentation, physical examination findings, type and duration of conservative management, indications for surgical intervention, complications, and postoperative outcomes.RESULTSOver the 19-year study period, 199 patients underwent LMD at the authors’ institution. The mean age at presentation was 16.0 years (range 12–18 years), and 55.8% were female. Of these patients, 70.9% participated in competitive sports, and among those who did not play sports, 65.0% had a body mass index greater than 25 kg/m2. Prior to surgery, conservative management had failed in 98.0% of the patients. Only 3 patients (1.5%) presented with cauda equina syndrome requiring emergent microdiscectomy. Complications included 4 cases of postoperative CSF leak (2.0%), 1 case of a noted intraoperative CSF leak, and 3 cases of wound infection (1.5%). At the first postoperative follow-up appointment, minimal or no pain was reported by 93.3% of patients. The mean time to return to sports was 9.8 weeks. During a mean follow-up duration of 8.2 years, 72.9% of patients did not present again after routine postoperative appointments. The total risk of reoperation was a rate of 7.5% (3.5% of patients underwent reoperation for the same level; 4.5% underwent adjacent-level decompression, and one patient [0.5%] ultimately underwent a fusion).CONCLUSIONSMicrodiscectomy is a safe and effective treatment for long-term relief of pain and return to daily activities among pediatric patients with symptomatic lumbar disc disease in whom conservative management has failed.

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