Sangjoon Chong1,2, Ji Yeoun Lee2,3, Kyung Hyun Kim2, Hyung-Ik Shin4, Keewon Kim4, Kwanjin Park5, Seung-Ki Kim2, Kyu-Chang Wang6. 1. Department of Neurosurgery, Asan Medical Center, Seoul, Republic of Korea. 2. Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea. 3. Department of Anatomy, College of Medicine, Seoul National University, Seoul, Republic of Korea. 4. Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Republic of Korea. 5. Department of Urology, Seoul National University Hospital, Seoul, Republic of Korea. 6. Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea. kcwang@snu.ac.kr.
Abstract
BACKGROUND: Indication, timing, and method for surgical treatment of lumbosacral lipoma are controversial. Radical resection of the lumbosacral lipoma and complete reconstruction of the placode are supported in that better long-term outcome can be achieved without increasing complication rate compared with traditional surgical techniques. OBJECTIVE: We analyzed the early surgical outcomes of lumbosacral lipoma treated with the untethering and radical excision of fat. METHODS: Retrospective analysis of surgically treated 81 fresh lumbosacral lipoma cases with dorsal, transitional, and chaotic types and true lipomyelomeningocele (LMMC) was performed. Caudal and filar types were excluded. RESULTS: Complete untethering was accomplished in 98%. Radical excision of the lipoma was attempted in all cases and achieved in 83%. Postoperative neurological complication was observed in 8 cases (10%). Group of lipoma types (dorsal + transitional vs. chaotic + true LMMC) and availability of radical lipoma excision turn out to be factors related to neurological outcomes in univariate analysis (p < 0.001 and p = 0.027, respectively). Group of lipoma types, availability of radical excision, and postoperative cord/dural sac (C/D) ratio are related factors in multivariate analysis (p = 0.025, p = 0.049, and p = 0.031). CONCLUSIONS: As a follower of untethering and radical excision of fat, careful consideration is required to plan the surgery of lumbosacral lipoma on account of the "underestimated" complication rate. Type of the lipoma is the important factor determining the surgical outcome. Availability of complete radical excision and postoperative C/D ratio are the operative factors related to the neurological outcomes.
BACKGROUND: Indication, timing, and method for surgical treatment of lumbosacral lipoma are controversial. Radical resection of the lumbosacral lipoma and complete reconstruction of the placode are supported in that better long-term outcome can be achieved without increasing complication rate compared with traditional surgical techniques. OBJECTIVE: We analyzed the early surgical outcomes of lumbosacral lipoma treated with the untethering and radical excision of fat. METHODS: Retrospective analysis of surgically treated 81 fresh lumbosacral lipoma cases with dorsal, transitional, and chaotic types and true lipomyelomeningocele (LMMC) was performed. Caudal and filar types were excluded. RESULTS: Complete untethering was accomplished in 98%. Radical excision of the lipoma was attempted in all cases and achieved in 83%. Postoperative neurological complication was observed in 8 cases (10%). Group of lipoma types (dorsal + transitional vs. chaotic + true LMMC) and availability of radical lipoma excision turn out to be factors related to neurological outcomes in univariate analysis (p < 0.001 and p = 0.027, respectively). Group of lipoma types, availability of radical excision, and postoperative cord/dural sac (C/D) ratio are related factors in multivariate analysis (p = 0.025, p = 0.049, and p = 0.031). CONCLUSIONS: As a follower of untethering and radical excision of fat, careful consideration is required to plan the surgery of lumbosacral lipoma on account of the "underestimated" complication rate. Type of the lipoma is the important factor determining the surgical outcome. Availability of complete radical excision and postoperative C/D ratio are the operative factors related to the neurological outcomes.
Authors: Guillermo Paradiso; Gabriel Y F Lee; Roger Sarjeant; Ly Hoang; Eric M Massicotte; Michael G Fehlings Journal: Spine (Phila Pa 1976) Date: 2006-08-15 Impact factor: 3.468
Authors: Philippe De Vloo; Julia Sharma; Lucy Alderson; Ivana Jankovic; M Zubair Tahir; Divyesh Desai; Dachling Pang; Dominic N P Thompson Journal: Childs Nerv Syst Date: 2022-03-09 Impact factor: 1.532