Leptomyelolipoma: analysis of 20 cases

Leptomyelolipoma (lumbosacral lipoma) is a common form of spinal dysraphism. The deficits produced include sensory, motor, bowel, and bladder dysfunction, and vary in incidence between the pediatric and adult populations. Twenty patients treated surgically at the Mount Sinai Hospital between 1972 and 1988 are reviewed. Fifty percent were 12 years of age or less and 50% were older than 18 years of age. The surgical approach was designed to accomplish untethering of the conus medullaris, debulking of the lipomatous mass compressing the cord, reconstruction of the dural canal, and reapproximation of the paraspinal muscles and lumbosacral fascia to prevent future trauma. Postoperatively, no patient experienced deterioration of neurological function. Of the symptomatic patients. 67% displayed dramatic improvement or became asymptomatic and 33% experienced stabilization of their deficits. The symptoms most resistant to surgical correction were orthopedic foot deformities and bowel dysfunction, whereas bladder dysfunction, motor weakness, and radiculopathies were most amenable to surgical therapy. Early surgical repair is recommended in these cases to forestall irreversible neurological damage.