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Lumbosacral lipomas: in utero diagnosis and prognosis
Alain Pierre-Kahn1, Pascale Sonigo
1Service de Neurochirurgie Pédiatrique, Groupe Hospitalier Necker-Enfants Malades, 149 rue de Sèvres, 75743 Paris Cedex 15, France. alain.kahn@nck.ap-hop-paris.fr
Insights
Accurate prenatal diagnosis of spinal dysraphism is crucial. Differentiating lipomas from myelomeningoceles using fetal biology and ultrasound is key, as lipomas generally have a favorable prognosis.
Area of Science:
- Prenatal diagnosis
- Fetal medicine
- Neurology
Background:
- Accurate prenatal diagnosis of spinal dysraphism is essential for counseling and prognostication.
- Recognizing diverse forms of spinal dysraphism requires understanding key diagnostic criteria.
Purpose of the Study:
- To highlight the importance of distinguishing between different types of spinal dysraphism prenatally.
- To emphasize the critical differences between lipomas and myelomeningoceles.
Main Methods:
- Prenatal ultrasound examination.
- Fetal biology assessment.
- Distinguishing features of lipomas (skin-covered, normal amniotic fluid/intracranial content) versus myelomeningoceles.
Main Results:
- Lipomas and myelomeningoceles can be clearly distinguished prenatally via ultrasound and fetal biology.
- Lipomas typically present with a favorable prognosis, unlike myelomeningoceles which carry a high risk of neurological deficits.
- Distinguishing lipomas from meningoceles can be challenging, but specific ultrasound findings like thick skin and intradural echoes may suggest lipoma.
Conclusions:
- The distinction between lipomas and myelomeningoceles is critical due to vastly different prognoses.
- Most occult spinal dysraphic lesions, including lipomas, have a favorable outcome.
- Misdiagnosis of lipoma as other occult dysraphic lesions has minimal consequences.
Introduction:
For the purposes of prenatal counselling and prognostication, it is essential to keep in mind the key diagnostic criteria allowing recognition of the diverse forms of spinal dysraphism.
Diagnosis:
It is most crucial not to confuse lipomas and myelomeningoceles, the former carrying a usually favourable prognosis, while the latter a high risk of serious neurological deficits. In our experience, these two conditions can be clearly distinguished on prenatal ultrasound and by fetal biology. Lipomas are skin-covered, which explains the normality of the amniotic fluid and probably that of the intracranial content (no Chiari, no hydrocephalus). These features are distinct from those observed in the case of myelomeningoceles. The distinction between a lipoma and a meningocele is more difficult. The prenatal ultrasound presentation of many lipomas actually resembles that of a meningocele. In a few cases, the diagnosis of lipoma can, however, be suspected by the presence of an abnormally thick skin covering and intradural echoic structures that evoke a low-lying cord.
Conclusions:
However, the consequences of confusing a lipoma and most of the other types of occult dysraphism are minimal. Most of these lesions carry a favourable outcome.