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Lumbosacral lipomas with spina bifida.

J F Hirsch1, A Pierre-Kahn

  • 1Hôpital Necker Enfants-Malades, Service de Neurochirurgie Pédiatrique, Paris, France.

Child'S Nervous System : Chns : Official Journal of the International Society for Pediatric Neurosurgery
|December 1, 1988
PubMed
Summary

Early surgery for lumbosacral lipomas is crucial. Surgical intervention offers better outcomes and lower deterioration rates compared to non-operative management, preventing neurological complications.

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Area of Science:

  • Neurosurgery
  • Pathology
  • Developmental Biology

Background:

  • Lumbosacral lipomas are congenital tumors with varied pathological and functional characteristics.
  • Understanding their evolution is key to effective management.
  • Spontaneous clinical worsening occurs in a significant percentage of cases.

Purpose of the Study:

  • To analyze the pathological, metabolic, and functional aspects of lumbosacral lipomas.
  • To evaluate the efficacy and safety of surgical treatment.
  • To identify mechanisms of clinical deterioration and classify lipoma types.

Main Methods:

  • Retrospective study of 73 patients operated on for lumbosacral lipomas between 1970 and 1983.
  • Pathological examination of tumor composition (adipocytes, fibrous tissue, vessels, nerve fibers).
  • Metabolic analysis of lipogenesis and lipolysis, and assessment of clinical outcomes post-surgery.

Main Results:

  • Lipomas composed mainly of adipocytes, with some cases showing innervated muscle fibers.
  • Metabolic activity (lipogenesis/lipolysis) similar to normal fat tissue, but lipomas can grow.
  • Surgery demonstrated nil mortality, low early (2.7%) and late (6%) deterioration rates compared to non-operative (36-56%) rates.
  • Three mechanisms of worsening identified: cord compression, stretching, or injury, leading to distinct lipoma types.

Conclusions:

  • Lumbosacral lipomas exhibit specific pathological and metabolic features.
  • Surgical treatment is safe and effective, significantly reducing long-term deterioration.
  • Early and systematic surgical intervention is necessary to prevent progressive neurological deficits.

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