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Intraspinal lipomas in infancy and childhood causing a tethered cord syndrome
D Stolke1, M Zumkeller, V Seifert
1Neurosurgical Clinic, Medical School Hanover, West Germany.
Insights
This study examines 26 children with spina bifida occulta and intraspinal lipoma, highlighting surgical outcomes for tethered cord syndrome. Early intervention is crucial for managing neurological deterioration in pediatric patients.
Area of Science:
- Pediatric Neurosurgery
- Spinal Dysraphism
- Neurology
Background:
- Spina bifida occulta with intraspinal lipoma can cause tethered cord syndrome.
- Clinical manifestations include skin lesions, foot deformities, and bladder/bowel dysfunction.
- Diagnosis relies on advanced neuroradiological imaging.
Purpose of the Study:
- To analyze the clinical presentation and surgical outcomes in children with spina bifida occulta and intraspinal lipoma.
- To evaluate the efficacy of surgical intervention for tethered cord syndrome in this pediatric cohort.
- To discuss the optimal timing for surgical intervention.
Main Methods:
- Retrospective review of 26 pediatric patients.
- Diagnostic imaging included myelography, CT, and MRI.
- Surgical indications based on imaging and neurological status.
Main Results:
- Patients presented with a range of symptoms from 1 month to 12 years of age.
- Surgical treatment was performed based on radiological findings and clinical deterioration.
- Outcomes of operative treatment were assessed.
Conclusions:
- Surgical intervention is indicated for intraspinal lipoma and tethered cord syndrome in children with spina bifida occulta.
- The timing of surgery, including prophylactic measures, is critical for preventing neurological deficits.
Abstract:
The authors report on a series of 26 children with spina bifida occulta in combination with intraspinal lipoma and clinical signs of tethered cord syndrome. The age of the children at presentation ranged from 1 month to 12 years. The typical signs and symptoms consisted of skin lesions in the lumbar-sacral region, neurogenic foot deformities, and bladder and bowel disturbances. The diagnosis was confirmed by neuroradiological investigations including lumbar myelography, computerized tomography, and only recently magnetic resonance imaging. Indications for surgery were based on the radiological evidence of intraspinal lipoma and tethered cord and especially on the clinical signs of neurological deterioration. The results of the operative treatment are presented and the role of surgery before onset of symptoms as well as during the symptom-free interval is discussed.