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Spinal lipomas in children--surgical management and long-term follow-up
Kazuyoshi Morimoto1, Osamu Takemoto, Akatsuki Wakayama
1Department of Neurosurgery, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan. fr8kmrmt@mch.pref.osaka.jp
Insights
Magnetic Resonance (MR) imaging refined spinal pathology diagnosis in children with spinal lipomas. While filum lipomas are safely treated, conus lipomas present more complex surgical outcomes.
Area of Science:
- Pediatric Neurosurgery
- Spinal Cord Imaging
- Congenital Spinal Abnormalities
Background:
- Spinal lipomas are congenital tumors often associated with spinal dysraphism.
- Magnetic Resonance (MR) imaging has significantly improved the diagnosis and management of spinal pathologies.
- Lumbosacral cutaneous stigmata in children can indicate underlying spinal cord abnormalities.
Purpose of the Study:
- To investigate the surgical outcomes of children diagnosed with spinal lipomas.
- To analyze reoperation rates and reasons for reoperation in a pediatric cohort.
- To compare the outcomes of filum lipomas versus conus lipomas.
Main Methods:
- Retrospective review of 76 children with tethered cords, including 67 with spinal lipomas, treated between 1991 and 2003.
- Analysis of surgical procedures, patient demographics, and follow-up data.
- Categorization of reoperation causes, including lipoma multiplication, urologic, orthopedic, and cerebrospinal fluid (CSF) leakage complications.
Main Results:
- The reoperation rate for symptomatic or clinical signs was 16.4% (11 cases) after the introduction of MR imaging.
- Common reasons for reoperation included lipoma regrowth (3), urologic symptoms (3), orthopedic signs (5), and CSF leakage (2).
- Filum lipomas demonstrated favorable surgical outcomes, whereas conus lipomas were associated with more challenging management.
Conclusions:
- MR imaging has enhanced the diagnostic capabilities for pediatric spinal lipomas.
- Surgical intervention for spinal lipomas can be effective, but reoperations are sometimes necessary.
- Filum lipomas generally have a good prognosis post-surgery, unlike conus lipomas which require more complex care.
Abstract:
Since its introduction, MR imaging has been easy to perform on all children with lumbosacral cutaneous stigmata, and has enabled the phenomenal refinement of spinal pathology. We investigated the overall outcomes of children with spinal lipomas at the Osaka Medical Center and Research Institute for Maternal and Child Health in Osaka, Japan. Between 1991 and 2003, 76 children with a tethered cord underwent a total of 90 surgical procedures at our institutes. Of this cohort, 67 cases had spinal lipomas. The mean age of patients at first operation for asymptomatic lipoma was 22.4 months (range: 1 month to 16 years, trim mean: 10.1 months, mode: 5 months), except 4 cases. The mean total follow-up for the cohort since the first surgical procedure was 7.2 years (trim mean: 7.9 years). Since the introduction of MR imaging, the reoperation rate for symptoms or signs in our series was 16.4% (11 cases). Regarding the 13 subsequent reoperations (2 patients had 2 operations), 3 patients were reoperated on due to multiplication of the lipomas after untethering, 3 due to urologic symptoms and 5 due to orthopedic signs. There were 2 cases who also had to undergo reoperation early due to CSF leakage. Filum and conus lipomas have similar tethering pathologies, but differ in the outcome following surgery. Filum lipomas are benign, and therefore surgery is safe and effective. Conus lipomas are more difficult to manage.