Adolescent lumbar disc herniation: Experience from a large minimally invasive treatment centre for lumbar degenerative disease in Chongqing,China

Purpose

This article discusses the aetiology, medical history, physical examination, imaging characteristics and treatment modalities relevant to this entity aiming to increase awareness among paediatricians regarding LDH (lumbar disc herniation) in young children.

Methods

We retrospectively reviewed the medical records of 120 adolescent patients (aged 13–20 years old) with LDH at the orthopaedics department of a teaching hospital in Chongqing, China, between 2001 and 2011.

Results

The present retrospective analysis was performed on 121 adolescent patients (2.6%, 121/4695 cases with LDH operations) with LDH. One hundred and thirteen patients (93.4%) presented with low back pain with or without radiculopathy, and 12 patients (9.9%) presented with leg pain as the first symptom. Only 60 patients (49.6%) were diagnosed with LDH as their first outpatient diagnosis. Thirty-eight patients (31.4%) had a history of trauma before the onset of their symptoms. The most common segments were L4/5 (61, 50.4%), L5/S1 (42, 34.7%) and L4/5 + L5/S1 (13, 10.7%). Disc herniation was centrolateral in 77.7% (n = 94) and central in 35.5% (n = 43). Eighty patients were treated by MED (microendoscopy discectomy), 25 by PELD (percutaneous endoscopic lumbar discectomy) and 16 by OLD (open lumbar discectomy). The rate of operative complications was 3.8%, 4.0% and 6.3% in MED, PELD and OLD, respectively. Through the ordinal regression analysis, we found that the patients with central disc herniation had much better outcomes than the patients with centrolateral disc herniation (P = 0.046).

Conclusions

Diagnosis of LDH in young children is usually delayed, but there were no risk factors for the delayed outpatient diagnosis of LDH. Awareness of LDH will help the paediatrician extract a relevant medical history, perform a directed physical examination and order appropriate imaging studies.     

Percutaneous bipolar radiofrequency thermocoagulation for the treatment of lumbar disc herniation

Lumbar disc herniation is usually managed with conservative treatment or surgery. However, conservative therapy seldom yields good results, and surgery is associated with multiple complications. This study aimed to assess bipolar radiofrequency thermocoagulation for the treatment of lumbar disc herniation. A total of 168 patients with lumbar disc herniation suitable for radiofrequency thermocoagulation were enrolled and randomized to monopolar radiofrequency thermocoagulation (control group, n = 84) or bipolar radiofrequency thermocoagulation (experimental group, n = 84) treatment groups. Ablation sites were targeted under CT scan guidance, and consecutive radiofrequency therapy was used. One and two probes were used for monopolar and bipolar thermocoagulation, respectively. Thermocoagulation was achieved at 50°C, 60°C, and 70°C for 60 s each, 80°C for 90 s, and 92°C for 100 s. Symptoms and complications were evaluated using the modified Macnab criteria and Visual Analog Scale at 7, 30, and 180 days postoperatively. At 180 days, a significantly higher efficacy rate was obtained in the experimental group compared with control patients (91.6% versus 79.7%, P < 0.05). No severe complications were occurred in either group. Targeted ablation via bipolar radiofrequency thermocoagulation is efficient for lumbar disc herniation treatment, and should be further explored for broad clinical application.     

The role of matrix metalloproteinase 9 in intervertebral disc degeneration

The present study investigates the histological alterations and expression of matrix metalloproteinase 9 (MMP-9) in disc specimens of 43 patients who underwent surgery for lumbar disc herniation. The immunostaining for MMP-9 was evaluated semi-quantitatively. Histologic degeneration was scored between 0 and 12 depending on the degree of chondrocyte proliferation and presence of tears and clefts, granular changes and mucous degeneration. Herniation was graded as grade 1 (protrusion), grade 2 (extrusion) or grade 3 (sequestration) on MRI. Although there was no significant statistical difference between the histologic degeneration score and age, degenerative changes were more pronounced in higher grade of herniation (p < 0.0001). MMP-9 expression was related to histologic degenerative score in all age groups (p = 0.0065). MMP-9 was also related to herniation grade in patients younger than 30 years of age (p = 0.0037). No significant association was found between MMP-9 expression and herniation grade in patients who were 30–60 years or over 60 years of age.     

Gender differences in the 3-month utilization of nonoperative therapies prior to primary lumbar microdiscectomy

Patients with lumbar intervertebral disc herniation classically trial a brief course of conservative management prior to microdiscectomy surgery. Gender differences have previously been identified in the selection and symptomatic response to commonly-utilized nonoperative treatments. However, whether gender differences exist in the degree and cost of nonoperative therapy in this cohort remains unknown. Therefore, the purpose of this study was to assess for gender differences in the utilization and costs of nonoperative therapy in patients diagnosed with symptomatic lumbar intervertebral disc herniation 3-months prior to undergoing microdiscectomy. Medical records from adult patients diagnosed with a lumbar intervertebral disc herniation undergoing index microdiscectomy procedures from 2007 to 2017 were collected retrospectively from a large insurance database. The utilization of nonoperative therapy within 3-months after initial lumbar herniation diagnosis was determined. A total of 13,106 patients (55.4% Males) underwent index microdiscectomy. Male patients were more likely to fail conservative management and opt for surgery (Males: 2.9% vs. Females: 1.8%, p < 0.0001). A greater percentage of female patients utilized muscle relaxants (p = 0.0049), lumbar epidural steroid injections (p = 0.0007), and emergency department services (p = 0.001). The total direct cost of conservative treatment prior to microdiscectomy was $13,205,924, with males accountable for $7,457,023 (56.5%). When normalized by number of patients utilizing the respective therapy, males used fewer units of NSAIDs (males: 84.2 pills/patient; females: 97.3 pills/patient) and muscle relaxants (males: 77.5 pills/patient; females: 89.0 pills/patient). These results suggest that gender differences exist in the utilization of nonoperative therapies for the management of a lumbar intervertebral herniated disc prior to microdiscectomy surgery.     

Surgery for lumbar disc herniation: Analysis of 500 consecutive patients treated in an interdisciplinary spine centre

Surgical removal of a symptomatic herniated lumbar disc is performed either with or without the support of a microscope. Up to the time of writing, the literature has reported similar clinical outcomes for the two procedures. Five hundred consecutive patients, operated upon for primary single-level lumbar disc herniation in our University Spine Center between 2003–2011, with (n = 275), or without (n = 225), the aid of a microscope were included. Data were retrospectively analyzed, comparing the primary endpoint of clinical outcome and the secondary endpoints of complications, surgical time and length of hospitalization. Clinical outcomes and reoperation rates were comparable in both groups. Surgical time was significantly shorter with a mean time of 47 minutes without use of the microscope compared to the mean time of 87 minutes (p < 0.001) with the use of the microscope. Mean length of hospitalization was shorter in those operated with the microscope (5.3 days) compared to those without (6.1 days, p = 0.004). There was no difference in rates of complications. Microdiscectomy versus open sequestrectomy and discectomy for surgical treatment of lumbar disc herniation is associated with similar clinical outcomes and reoperation rates. Open sequestrectomy is associated with shorter operation times. Microdiscectomy is associated with shorter hospitalization stays.     

Mood and anxiety disorders in patients with chronic low back and neck pain caused by disc herniation

Objective: We investigated the prevalence of mood and anxiety disorders in patients with chronic low back and neck pain caused by disc herniation and the relationships between pain and mood, and anxiety disorders.

Methods: In total, 149 patients with disc herniation and 60 healthy subjects were included. Disc herniation was diagnosed based on a physical examination and magnetic resonance imaging. Mood and anxiety disorders were diagnosed using the Structured Clinical Interview of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition/Clinical Version.

Results: The mean age of the study subjects (n?=?209) was 45.96?±?11.45 years. Seventy (46.6%) patients with disc herniation met the criteria for at least one mood or anxiety disorder. The prevalence rates of mood and anxiety disorders were 16.6% and 35.8%, respectively. The most common specific diagnoses were major depression (n?=?25, 16.9%) and generalised anxiety disorder (n?=?19, 12.8%).

Conclusions: Mood and anxiety disorders were more commonly seen in patients with lumbar or cervical disc herniation than in those without herniation. No relationship was detected between pain severity and mood or anxiety disorders. However, mood and anxiety disorders were associated with neurological deficits.     

Microdiscectomy with and without insertion of interspinous device for herniated disc at the L5–S1 level

The role of interspinous devices (ISD) after lumbar herniated disc surgery for the prevention of postoperative back pain is controversial. The aim of this comparative prospective study was to determine outcomes in a selective cohort with L5–S1 disc herniation and degenerative disc changes after microdiscectomy with or without insertion of an ISD. One hundred and two consecutive patients underwent an L5–S1 microdiscectomy with or without implantation of an ISD. Group 1 consisted of 47 patients, with mild (n = 22), moderate (n = 14) or severe (n = 11) degenerative disc changes who had microdiscectomy alone. Group 2 comprised 45 patients with similar types of disc changes who underwent microdiscectomy with an ISD implant. The Visual Analogue Scale (VAS) was used to grade low-back pain and postoperative clinical status was rated according to the modified MacNab criteria. Mean VAS score for low-back pain improved significantly at 1 year follow-up from 7.3 at baseline to 2.75 (p < 0.001) in Group 1 and from 6.7 to 1.5 (p = 0.001) in Group 2. VAS score at 1 year showed significant improvements in 21 Group 1 patients versus 30 Group 2 patients (p = 0.001). Forty four percent of Group 1 patients and 80% of Group 2 patients showed improvement using the modified MacNab criteria. Patients in both groups reported significant improvement in sciatic pain and disability after microdiscectomy with or without an ISD implant. Patients with mild degenerative disc changes were more likely to achieve improvement of their low-back pain when treated with both microdiscectomy and ISD insertion.     

Comparison of the biochemical and radiological criteria for lumbar disc degeneration

Background

The relationship between radiological degeneration criteria on lumbar magnetic resonance imaging (MRI) and both the keratan sulfate (KS) and chondroitin sulfate (ChS) levels was examined in disc material taken from patients undergoing lumbar disc herniation (LDH) surgery. To examine whether the biochemical and radiological degeneration criteria testing the reliability of radiological degeneration findings agreed and to evaluate the contribution of the KS/ChS ratio to disc form (protruding or extruding).

Changes in the Cross-Sectional Area of Multifidus and Psoas in Unilateral Sciatica Caused by Lumbar Disc Herniation

Objective

To quantitatively evaluate the asymmetry of the multifidus and psoas muscles in unilateral sciatica caused by lumbar disc herniation using magnetic resonance imaging (MRI).

Methods

Seventy-six patients who underwent open microdiscectomy for unilateral L5 radiculopathy caused by disc herniation at the L4-5 level were enrolled, of which 39 patients (51.3%) had a symptom duration of 1 month or less (group A), and 37 (48.7%) had a symptom duration of 3 months or more (group B). The cross-sectional areas (CSAs) of the multifidus and psoas muscles were measured at the mid-portion of the L4-5 disc level on axial MRI, and compared between the diseased and normal sides in each group.

Results

The mean symptom duration was 0.6±0.4 months and 5.4±2.7 months for groups A and B, respectively (p<0.001). There were no differences in the demographics between the 2 groups. There was a significant difference in the CSA of the multifidus muscle between the diseased and normal sides (p<0.01) in group B. In contrast, no significant multifidus muscle asymmetry was found in group A. The CSA of the psoas muscle was not affected by disc herniation in either group.

Conclusion

The CSA of the multifidus muscle was reduced by lumbar disc herniation when symptom duration was 3 months or more.     

Occurrence of discal and non-discal changes after sequestrectomy alone versus sequestrectomy and implantation of an anulus closure device

Sequestrectomy alone represents a procedure for the treatment of lumbar disc herniation. For selected cases, an anulus closure device (ACD) can be implanted which may result in lower reoperation rates. However, comparative magnetic resonance imaging (MRI) changes and their clinical relevance of both procedures are unclear and have not been reported so far.Clinical and MRI data of patients after limited discectomy with ACD implantation (group ACD; N = 45) and patients after sequestrectomy alone (group S; N = 40) with primary lumbar disc herniation were compared retrospectively. Pain intensity on the visual analogue pain scale (VAS), oswestry disability index (ODI) or the patient satisfaction index (PSI) were collected. Disc signal intensity, Modic type changes, endplate reactions, anular tears and reherniations were investigated using MRI before and <18 months postoperative. Morphologic changes were correlated with clinical outcome.There was no difference in VAS back, VAS leg or ODI/PSI after the operation although group S showed significantly more reherniations in MRI. The overall rate of repeated surgery at the same level was similar with a trend in favour of the ACD group (P = 0.729). Significantly more patients of the ACD group experienced endplate erosions after surgery (P < 0.001). Both groups experienced progression of disc signal intensity, Modic type changes, and anular tears with most MRI signs being without clinical relevance.ACD implantation is associated with a significantly lower reherniation rate in MRI but showed a significantly higher rate of endplate erosions. The structural changes do not appear to be clinically relevant.     

Comparison of Percutaneous Endoscopic Lumbar Discectomy and Open Lumbar Microdiscectomy for Recurrent Disc Herniation

Objective

The purpose of this study was to compare clinical and radiological outcomes of percutaneous endoscopic lumbar discectomy (PELD) and open lumbar microdiscectomy (OLM) for recurrent disc herniation.

Methods

Fifty-four patients, who underwent surgery, either PELD (25 patients) or repeated OLM (29 patients), due to recurrent disc herniation at L4-5 level, were divided into two groups according to the surgical methods. Excluded were patients with sequestrated disc, calcified disc, severe neurological deficit, or instability. Clinical outcomes were assessed using Visual Analogue Scale (VAS) score and Oswestry Disability Index (ODI). Radiological variables were assessed using plain radiography and/or magnetic resonance imaging.

Results

Mean operating time and hospital stay were significantly shorter in PELD group (45.8 minutes and 0.9 day, respectively) than OLM group (73.8 minutes and 3.8 days, respectively) (p < 0.001). Complications occurred in 4% in PELD group and 10.3% in OLM group in the perioperative period. At a mean follow-up duration of 34.2 months, the mean improvements of back pain, leg pain, and functional improvement were 4.0, 5.5, and 40.9% for PELD group and 2.3, 5.1, and 45.0% for OLM group, respectively. Second recurrence occurred in 4% after PELD and 10.3% after OLM. Disc height did not change after PELD, but significantly decreased after OLM (p = 0.0001). Neither sagittal rotation angle nor volume of multifidus muscle changed significantly in both groups.

Conclusion

Both PELD and repeated OLM showed favorable outcomes for recurrent disc herniation, but PELD had advantages in terms of shorter operating time, hospital stay, and disc height preservation.     

A systematic review and meta-analysis of outcomes in hybrid constructs for multi-level lumbar degenerative disc disease

A systematic review and meta-analysis was performed to assess the effect of hybrid constructs which involve a total disc arthroplasty (TDA) with stand-alone anterior lumbar interbody fusion (ALIF) versus non-hybrid constructs including multi-level TDA, multi-level transforaminal lumbar interbody fusion (TLIF) with posterior transpedicular fixation or multi-level stand-alone ALIF as a surgical intervention for degenerative disc disease (DDD) in the lumbar spine. Primary outcomes analysed included the Oswestry Disability Index (ODI) and the Visual Analogue Scale (VAS) for back pain. A systematic search of Medline, Embase, Pubmed, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and Google Scholar was undertaken by two separate reviewers and a meta-analysis of the outcomes was performed. Three studies met our search criteria. When comparing hybrid constructs to multi-level TDA or lumbar fusion (LF) improvements in back pain were found with a VAS back pain score reduction of 1.38 (P < 0.00001) postoperatively and a VAS back pain score reduction of 0.99 points (P = 0.0006) at 2-years follow-up. Results so far slightly favour clinically significant improved VAS back pain score outcomes postoperatively and at 2-years follow-up for hybrid constructs in multi-level lumbar DDD of the spine when compared with non-hybrid multi-level LF or TDA. It cannot however be concluded that a hybrid construct is superior to multi-level LF or TDA based on this meta-analysis. The results highlight the need for further prospective studies to delineate best practice in the management of degenerative disc disease of the lumbar spine.     

Prognostic role of depression after lumbar disc surgery

Abstract. A total of 73 patients underwent microdiscectomy for lumbar disc herniation between September 2001 and May 2002 at the Department of Neurosurgery of the Second University of Naples. Preoperatively and 3 and 6 months after surgery, patients were assessed on the Zung Self-rating Depression Scale (SDS) and on a visual analogue scale (VAS) for the subjective perception of pain. At 3 and 12 months, we found that patients with lower SDS scores (n=41) had a better outcome regarding pain than patients with relevant depressive symptoms (n=32). In agreement with the literature, our results confirm the negative role of depression in outcome after lumbar disc surgery. We emphasize the consideration of psychological factors in the management of lumbar disc herniation.     

Lumbar disc herniation surgery: Is it worth adding interspinous spacer or instrumented fusion with regard to disc excision alone?

BackgroundDiscectomy is sometimes associated with recurrence of disc herniation and pain after surgery. The evidence to use an interspinous dynamic stabilization system or instrumented fusion in association with disc excision to prevent pain and re-operation remains controversial. In this study, we analyzed if adding interspinous spacer or fusion, offers advantages in relation to microdiscetomy alone.MethodsPatients with lumbar disc herniation were divided in 3 groups; microdiscectomy alone (MD), microdiscectomy plus interspinous spacer (IS) and open discectomy plus posterior lumbar interbody fusion (PLIF). The clinical efficacy was measured using the Owestry Disability Index (ODI). Other outcome parameters including visual analogue scale for pain (VAS) back and legs, length of stay, direct in-hospital cost, 90-day complication rate, and 1-year re-operation rate were also evaluated.ResultsA total of 103 patients whose mean age was 39.1 (±8.5) years were included. A significant improvement of the ODI and VAS back and legs pain baseline score was detected in the 3 groups. After 1 year, no significant differences in ODI, VAS back and legs pain were found between the 3 groups. There was an increase of 169% of the total direct in- hospital cost in IS group and 287% in PLIF group, in relation to MD (p < 0.001). Length of stay was 86% higher in the IS group and 384% longer in the PLIF group compared to MD (p < 0.001). The 1 year re-operation rates were 5.6%, 10% and 16.2% (p = 0.33). Discectomy seems to be the main responsible for the clinical improvement, without the interspinous spacer or fusion adding any benefit. The addition of interspinous spacer or fusion increased direct in-hospital cost, length of stay, and did not protect against re-operation.     

Significance of beaten copper appearance on skull radiographs in children with isolated sagittal synostosis

Aims and Objectives The significance of beaten copper appearance (BCA) on skull radiographs in children following surgery for isolated sagittal craniosynostosis has not been studied. This study was designed to look for any correlation between BCA and symptoms suggestive of intracranial hypertension in this group of patients. Materials and Methods Forty-eight consecutive children, who were operated for isolated sagittal synostosis from1987 to 2000 and had postoperative skull radiographs, were included. Patients were divided into: (a) BCA group (n = 20), consisting of children who had beaten copper appearance on skull radiographs at last follow up, and (b) Non-BCA group (n = 28), consisting of children who did not have this finding. Records were reviewed to look for symptoms suggestive of intracranial hypertension, such as headache, head banging, and irritability. Results Median age at surgery was 4.8 months for BCA group and 4 months for the non-BCA group. Follow up ranged from 4 to 156 months with a mean of 36.2 months. Total of 28.6% (n = 6) of the children with follow up radiographs done at ≤18 months of age had BCA. The incidence of BCA increased to 83.3% in children with skull radiographs performed after 48 months of age. In 18 (90%) children, the BCA was ‘diffuse’ with 5 (25%) children having the maximum possible score of 8. In the BCA group, 45% (n = 9) had symptoms compared to 10.7% (n = 3) in the control group (p = 0.0068). Conclusions This study suggests a significant number of children with BCA on radiographs develop symptoms suggestive of raised ICP following surgical treatment in infancy and prolonged follow up may be warranted in this group of patients.     

Lumbar Disc Herniation in Tae Kwon Do Athletic Child

Lumbar disc herniation is extremely uncommon in children below 10 years of age. A 7-year-old boy is reported who presented with low back pain and left leg radiating pain. The pain started seven days prior to presentation and was attributed to performing the jumping kick without any previous warm-up. Magnetic resonance imaging revealed a posterolateral disc herniation at the L3-4 level and multiple degenerative changes. The patient received conservative treatment including limitation of sports activities, anti-inflammatory and muscle relaxant medications as well as physical therapy. After three months of the aggressive treatment the child was symptom free. We present here a lumbar disc herniation in one of the youngest patient.     

医用臭氧治疗腰椎间盘突出症长期疗效分析

目的 评价经皮椎间盘内臭氧注射治疗腰椎间盘突出症的长期疗效. 方法回顾性分析南方医科大学珠江医院影像中心及南方医院介入治疗科自2002年7月至2004年3月应用臭氧治疗的324例腰椎间盘突出症患者的临床资料.所有患者均随访≥3年,比较术前和最后随访时日本骨科学会(JOA)评分及下肢根性痛的视觉模拟评分(VAS);运用改良的MacNab分级法记录最后随访的临床效果并评价患者年龄、病史长短、突出程度及类型等因素对治疗效果的影响. 结果本组患者JOA评分、下肢根性痛VAS术前及术后终末随访时比较差异均有统计学意义(6.3±1.4 vs 13.1±1.2,P=0.018;7.5±0.8 vs 2.1±0.3,P=0.039),JOA评分、VAS改善率分别为78.2%和70.4%;改良的MacNab分级法记录到最后随访时疗效优良率为77.5%(251/324),患者年龄、病程及椎间盘突出程度对疗效有明显影响;部分(33.8%)包含型突出患者治疗后近期可有症状"反跳".结论 臭氧治疗腰椎间盘突出症术后3年以上随访结果显示疗效令人满意,患者年龄、病程和椎间盘突出程度能影响患者疗效.     

Polymorphisms of RANTES and IL-4 Genes in Cerebral Infarction

Chemoattractant peptides (chemokines) and cytokines have been shown to play a key role in the inflammatory development and progression of cerebrovascular disease. The effect of polymorphisms in regulated upon activation, normal T cells expressed, and secreted (RANTES) and interleukin-4 (IL-4) genes on cerebral infarction (CI) is evaluated in this study. Patients with CI (n = 320) and healthy controls (n = 481) were genotyped for RANTES-403 and IL-4 variable number of tandem repeat (VNTR) polymorphisms using polymerase chain reaction (PCR) or PCR-restriction fragment length polymorphism. A significant difference was observed between the CI group and controls in subjects with the RANTES AA genotype in IL-4 A3− carriers (18.6% vs. 13.1%, P = 0.035, odds ratio = 1.5, 95% confidence interval = 1.03–2.25). These findings suggest that the RANTES G-403A allele increased the relative risk for CI in the subjects without the IL-4 VNTR allele 3.     

可撑开通道系统辅助下显微手术治疗腰椎间盘突出症

目的 探讨Caspar可扩张通道系统辅助下显微手术治疗腰椎间盘突出症的临床效果。方法 选取腰椎间盘突出症30例,在Caspar可撑开通道系统辅助下进行显微手术治疗。术前以及术后1、3、6、12个月,采用疼痛视觉模拟量表（VAS）评分评价疼痛缓解的情况,采用日本骨科协会（JOA）评分评价神经功能改善的情况。末次随访时,采用Macnab分级评价疗效。结果 手术时间为59~78 min,平均（68.50±7.20）min;术中出血量为25~60 ml,平均（32.25±8.6）ml。30例术后复查腰椎MRI均示突出的髓核全部摘除。术中硬脊膜破裂2例,严密修补硬脊膜,术后无脑脊液漏。术后无神经根、马尾神经损伤及椎间隙感染并发症发生。术后1、3、6、12个月VAS评分、JOA评分均明显优于术前（P<0.05）。按Macnab评价标准:优25例,良4例,可1例;优良率为96.7%（29/30）。术后随访1年未见复发。结论 采用Caspar可撑开通道系统辅助,显微手术治疗腰椎间盘突出症疗效确切,术野清晰,神经根减压彻底,对脊柱稳定结构破坏小,是治疗腰椎间盘突出症的一种安全有效的手术方式。     

Posterior fossa tumors in children: how long does it take to establish the diagnosis?

Objective The aim of this study is to evaluate, for our patient population, the time interval from the first chart-documented symptom to the radiological diagnosis in children and infants with posterior fossa tumors. Materials and methods We retrospectively analyzed 50 consecutive children (36 men, 14 women) with posterior fossa tumor treated at our department between January 1999 and December 2003. The mean age at time of diagnosis was 98 months (6 months–16 years). The mean follow up was 27 months (6–61 months). The diagnoses included astrocytoma (n = 17), medulloblastoma (n = 15), ependymoma (n = 6), and other tumors (n = 12). Results The mean time interval between onset of symptoms and radiographic diagnosis was 142 days (5–535 days), the median was 59 days. The mean time for Grade I and II tumors was 238 days (n = 19) and for tumors Grade III and IV 117 days (n = 31). The most common presenting symptoms were headache, nausea, vomiting, ataxia, and oculomotor deficits. Approximately half of the patients were initially diagnosed and treated for other diseases (gastrointestinal infection, appendicitis, psychological behavioral problems, cervical spine strains, different ophthalmologic entities). Specialists (ophthalmologists, orthopedics) tended to diagnose and treat their specific diagnoses (e.g., strabism, torticollis). Parents play a significant role in the process of establishing the correct diagnosis. Conclusion We conclude that further information and education regarding symptomatology and diagnosis of posterior fossa tumors in children is necessary. Communication has to be improved between parents and referring physicians of all specialties and neurosurgeons.