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Complex lumbosacral spinal cord lipomas: A longitudinal study on outcomes from a Singapore children's hospital
Jia Xu Lim1, Elizabeth Fong1, Cheryl Goh1
1Neurosurgical Service, KK Women's and Children's Hospital, ,00 Bukit Timah Road, Singapore 229899, Singapore.
Insights
Total/near-total resection (TR/NTR) of complex lumbosacral lipomas (CSL) in children is a feasible option. This approach helps prevent functional decline and re-tethering, though post-operative catheterization requires further study.
Area of Science:
- Pediatric Neurosurgery
- Spinal Cord Malformations
- Neurourology
Background:
- Complex lumbosacral lipomas (CSL) require surgical intervention for optimal outcomes.
- Total/near-total resection (TR/NTR) is associated with improved functional results and reduced re-tethering.
- Understanding factors influencing outcomes in pediatric CSL is crucial.
Purpose of the Study:
- To evaluate the institutional experience with TR/NTR for CSL in children.
- To identify factors affecting post-operative clean intermittent catheterization (CIC).
- To assess functional outcomes (Necker Functional Score - NFS) and re-tethering rates post-surgery.
Main Methods:
- Retrospective single-institution study of 122 pediatric patients with CSL (dorsal, transitional, chaotic).
- Patients categorized into 'prophylactic intent' (asymptomatic) and 'therapeutic intent' (symptomatic) groups.
- Analysis of factors influencing post-operative CIC, NFS, and re-tethering rates.
Main Results:
- 82% of patients achieved TR/NTR; 48.2% had favorable NFS at 1 year; 6.6% experienced re-tethering.
- Post-operative CIC associated with age, lipoma type, conus height, and prophylactic intent.
- Re-tethering linked to extent of resection and post-operative CSF leak.
- Favorable NFS associated with lipoma type and prophylactic intent.
Conclusions:
- TR/NTR for pediatric CSL is a viable surgical strategy to prevent functional deterioration and re-tethering.
- Further research is needed to address factors contributing to post-operative CIC.
- Prophylactic surgery and specific lipoma types correlate with better functional outcomes.
Background:
Total/near-total resection (TR/NTR) of complex lumbosacral lipomas (CSL) is reported to be associated with better long-term functional outcomes and lower symptomatic re-tethering rates. We report our institutional experience for CSL resection in affected children.
Methods:
This is a single-institution, retrospective study. Inclusion criteria consist of patients with CSL with dorsal, transitional and chaotic lipomas based on Pang et al's classification. The study population is divided into 2 groups: asymptomatic patients with a normal preoperative workup referred to as 'prophylactic intent' and 'therapeutic intent' for those with pre-existing neuro-urological symptoms. Primary aims are to review factors that affect post-operative clean intermittent catheterization (CIC), functional outcomes based on Necker functional score (NFS), and re-tethering rates.
Results:
122 patients were included from 2000 to 2021. There were 32 dorsal lipomas (26.2 %), 74 transitional lipomas (60.7 %), and 16 chaotic lipomas (13.1 %). 82 % patients achieved TR/NTR. Favourable NFS at 1-year was 48.2 %. The re-tethering rate was 6.6 %. After multivariable analysis, post-operative CIC was associated with median age at surgery (p = 0.026), lipoma type (p = 0.029), conus height (p = 0.048) and prophylactic intent (p < 0.001). Next, extent of lipoma resection (p = 0.012) and the post-operative CSF leak (p = 0.004) were associated with re-tethering. Favourable NFS was associated with lipoma type (p = 0.047) and prophylactic intent surgery (p < 0.001).
Conclusions:
Our experience shows that TR/NTR for CSL is a feasible option to prevent functional deterioration and re-tethering. Efforts are needed to work on factors associated with post-operative CIC.
