Asymptomatic lipomas of the medullary conus: surgical treatment versus conservative management

Clinical article

View More View Less
  • 1 Department of Neurosurgery,
  • | 2 Service of Bio-Statistics, and
  • | 3 Centro Spina Bifida, Niguarda Ca'Granda Hospital, Milan, Italy
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
Print or Print + Online

Object

The goal of this study was to compare long-term results of surgery with the outcomes of conservative treatment in patients with asymptomatic lipomas of the conus medullaris.

Methods

The parents of 56 consecutive children with a diagnosis of asymptomatic lipoma of the conus medullaris underwent detailed neurosurgical consultation. The pros and cons of both prophylactic surgery and conservative treatment were carefully presented. Both options were offered, and the parents were free to choose the preferred management. A total of 32 children underwent surgical treatment, and 24 were conservatively treated. Afterward, all patients entered the same protocol of serial neurological and urological follow-up at the Centro Spina Bifida. The mean follow-up periods were 9.7 years in the surgical treatment group and 10.4 years in the conservative treatment group.

Results

Permanent surgical morbidity was 3.1% (1 patient). During follow-up, tethered cord syndrome occurred in 9.7% of the surgically treated patients (3 of 32 patients) and in 29.1% of the conservatively managed children (7 of 24 patients). This difference did not result in statistical significance, but a clear trend in favor of surgery emerged. Young age at surgery and a cord/sac ratio < 50% appeared to be determining factors in the prevention of subsequent tethered cord syndrome.

Conclusions

The small size of this series does not provide enough statistical evidence that surgical treatment can really improve the natural history of asymptomatic lipomas of the conus medullaris. Nevertheless, surgery appears at least advisable since it reduces by 75% the odds of TCS (p = 0.067), which is quite close to statistical significance.

Abbreviations used in this paper:

LCM = lipoma of the conus medullaris; TCS = tethered cord syndrome.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
  • 1

    Arai H, , Sato K, , Okuda O, , Miyajima M, , Hishii M, & Nakanishi H, et al.: Surgical experience of 120 patients with lumbosacral lipomas. Acta Neurochir (Wien) 143:857864, 2001

    • Search Google Scholar
    • Export Citation
  • 2

    Bruce DA, & Schut L: Spinal lipomas in infancy and childhood. Childs Brain 5:192203, 1979

  • 3

    Chapman PH, & Davis KR: Surgical treatment of spinal lipomas in childhood. Pediatr Neurosurg 19:267275, 1993

  • 4

    Cochrane DD: Cord untethering for lipomyelomeningocele: expectation after surgery. Neurosurg Focus 23:2 E9, 2007

  • 5

    Cochrane DD, , Finley C, , Kestle J, & Steinbok P: The patterns of late deterioration in patients with transitional lipomyelomeningocele. Eur J Pediatr Surg 10:Suppl 1 1317, 2000

    • Search Google Scholar
    • Export Citation
  • 6

    Colak A, , Pollack IF, & Albright AL: Recurrent tethering: a common long-term problem after lipomyelomeningocele repair. Pediatr Neurosurg 29:184190, 1998

    • Search Google Scholar
    • Export Citation
  • 7

    Drake JM: Surgical management of the tethered spinal cord—walking the fine line. Neurosurg Focus 23:2 E4, 2007

  • 8

    Finn MA, & Walker ML: Spinal lipomas: clinical spectrum, embryology, and treatment. Neurosurg Focus 23:2 E10, 2007

  • 9

    Hoffman HJ, , Hendrick EB, & Humphreys RP: The tethered spinal cord: its protean manifestations, diagnosis and surgical correction. Childs Brain 2:145155, 1976

    • Search Google Scholar
    • Export Citation
  • 10

    Hoffman HJ, , Taecholarn C, , Hendrick EB, & Humphreys RP: Management of lipomyelomeningoceles. Experience at the Hospital for Sick Children, Toronto. J Neurosurg 62:18, 1985

    • Search Google Scholar
    • Export Citation
  • 11

    Kanev PM, & Bierbrauer KS: Reflections on the natural history of lipomyelomeningocele. Pediatr Neurosurg 22:137140, 1995

  • 12

    Kanev PM, , Lemire RJ, , Loeser JD, & Berger MS: Management and long-term follow-up review of children with lipomyelomeningocele, 1952–1987. J Neurosurg 73:4852, 1990

    • Search Google Scholar
    • Export Citation
  • 13

    Kothbauer KF, & Novak K: Intraoperative monitoring for tethered cord surgery: an update. Neurosurg Focus 16:2 E8, 2004

  • 14

    Kulkarni AV, , Pierre-Kahn A, & Zerah M: Conservative management of asymptomatic spinal lipomas of the conus. Neurosurgery 54:868875, 2004

    • Search Google Scholar
    • Export Citation
  • 15

    La Marca F, , Grant JA, , Tomita T, & McLone DG: Spinal lipomas in children: outcome of 270 procedures. Pediatr Neurosurg 26:816, 1997

  • 16

    Lagae L, , Verpoorten C, , Casaer P, , Vereecken R, , Fabry G, & Plets C: Conservative versus neurosurgical treatment of tethered cord patients. Z Kinderchir 45:Suppl 1 1617, 1990

    • Search Google Scholar
    • Export Citation
  • 17

    McLone DG, Occult dysraphism and the tethered spinal cord. Choux M, , Di Rocco C, & Hockley A, et al.: Pediatric Neurosurgery London, Churchill Livingstone, 1999. 6178

    • Search Google Scholar
    • Export Citation
  • 18

    McLone DG, & La Marca F: The tethered spinal cord: diagnosis, significance, and management. Semin Pediatr Neurol 4:192208, 1997

  • 19

    Oakes WJ, Management of spinal cord lipomas and lipomyelomeningoceles. Wilkins RH, & Rengachary SS: Neurosurgery New York, McGraw-Hill, 1996. 34973504

    • Search Google Scholar
    • Export Citation
  • 20

    Ohe N, , Futamura A, , Kawada R, , Minatsu H, , Kohmura H, & Hayashi K, et al.: Secondary tethered cord syndrome in spinal dysraphism. Childs Nerv Syst 16:457461, 2000

    • Search Google Scholar
    • Export Citation
  • 21

    Pang D, , Zovickian J, & Oviedo A: Long-term outcome of total and near-total resection of spinal cord lipomas and radical reconstruction of the neural placode: part I—surgical technique. Neurosurgery 65:511529, 2009

    • Search Google Scholar
    • Export Citation
  • 22

    Pang D, , Zovickian J, & Oviedo A: Long-term outcome of total and near-total resection of spinal cord lipomas and radical reconstruction of the neural placode, part II: outcome analysis and preoperative profiling. Neurosurgery 66:253273, 2010

    • Search Google Scholar
    • Export Citation
  • 23

    Pierre-Kahn A, Management of lumbosacral lipomas. Sindou M: Practical Handbook of Neurosurgery Wien, Springer, 2009. 10851100

  • 24

    Pierre-Kahn A, , Zerah M, , Renier D, , Cinalli G, , Sainte-Rose C, & Lellouch-Tubiana A, et al.: Congenital lumbosacral lipomas. Childs Nerv Syst 13:298335, 1997

    • Search Google Scholar
    • Export Citation
  • 25

    Samuels R, , McGirt MJ, , Attenello FJ, , Garcés Ambrossi GL, , Singh N, & Solakoglu C, et al.: Incidence of symptomatic retethering after surgical management of pediatric tethered cord syndrome with or without duraplasty. Childs Nerv Syst 25:10851089, 2009

    • Search Google Scholar
    • Export Citation
  • 26

    Sarris CE, , Tomei KL, , Carmel PW, & Gandhi CD: Lipomyelomeningocele: pathology, treatment, and outcomes. A review. Neurosurg Focus 33:4 E3, 2012

    • Search Google Scholar
    • Export Citation
  • 27

    Talamonti G, , D'Aliberti G, & Collice M: Myelomeningocele: long-term neurosurgical treatment and follow-up in 202 patients. J Neurosurg 107:5 Suppl 368386, 2007

    • Search Google Scholar
    • Export Citation
  • 28

    von Koch CS, , Quinones-Hinojosa A, , Gulati M, , Lyon R, , Peacock WJ, & Yingling CD: Clinical outcome in children undergoing tethered cord release utilizing intraoperative neurophysiological monitoring. Pediatr Neurosurg 37:8186, 2002

    • Search Google Scholar
    • Export Citation
  • 29

    Zerah M, , Pierre-Kahn A, & Catala M, Lumbosacral lipomas. Choux M, , Di Rocco C, & Hockley A, et al.: Pediatric Neurosurgery London, Churchill Livingstone, 1999. 79100

    • Search Google Scholar
    • Export Citation
  • 30

    Zerah M, , Roujeau T, , Catala M, & Pierre-Kahn A, Spinal lipomas. Özek MM, , Cinalli G, & Maixner WJ: Spina Bifida: Management and Outcome Milan, Springer-Verlag, 2008. 445474

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 425 197 2
Full Text Views 715 23 1
PDF Downloads 320 17 1
EPUB Downloads 0 0 0