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Neurosurgical Management and Follow-up of Pediatric Lumbosacral Lipomas: A Single-Center Experience with 28 Patients
Efecan CEKiC1, Can KiVRAK, Adnan DAGCiNAR
1Polatli Duatepe State Hospital, Department of Neurosurgery, Ankara, Türkiye.
Insights
Surgical treatment for pediatric lumbosacral lipomas (LSL) shows benefits, but outcomes vary by lipoma type. Careful surgical planning is key to preserving neurological function and optimizing results in children with LSL.
Area of Science:
- Pediatric neurosurgery
- Spinal cord anomalies
- Congenital malformations
Background:
- Lumbosacral lipomas (LSL) are congenital spinal cord malformations.
- Surgical intervention is often necessary to address neurological deficits and prevent further deterioration.
Purpose of the Study:
- To evaluate surgical efficacy for pediatric lumbosacral lipomas (LSL).
- To analyze preoperative symptoms, postoperative outcomes, and long-term prognosis.
- To correlate lipoma characteristics with surgical results.
Main Methods:
- Retrospective review of 28 pediatric patients (aged 1-17) undergoing LSL resection (2018-2023).
- Assessment of surgical indications, techniques (neuromonitoring, resection extent), and postoperative management.
- Classification of LSLs based on location and spinal cord relationship; outcome assessment using Hoffmann grading and complication monitoring.
Main Results:
- Dorsal LSLs: 62.5% total resection, 37.5% symptomatic improvement.
- Caudal LSLs: 46.15% total resection, 30.77% symptom worsening.
- Transitional LSLs: 100% positive outcome with total resection.
- Chaotic LSLs: 40% deterioration after subtotal resection.
- Overall surgical complications: 17.8%.
Conclusions:
- Surgical management of symptomatic pediatric LSL offers significant benefits.
- Lipoma type critically influences surgical planning and patient outcomes.
- Tailored surgical approaches based on imaging and classification optimize results, especially for complex chaotic LSLs.
Aim:
To evaluate the efficacy of surgical interventions for pediatric lumbosacral lipomas (LSL) by focusing on preoperative symptoms, postoperative outcomes, and long-term prognosis.
Material And Methods:
The medical records and magnetic resonance images (MRI) of 28 pediatric patients (15 boys and 13 girls aged 1?17 years) who underwent LSL resection between 2018 and 2023 were retrospectively reviewed. The study assessed surgical indications, techniques (including using neuromonitoring and the extent of lipoma resection), and postoperative management. The LSLs were classified based on their location and relationship with the spinal cord, which informed the surgical approaches and prognostic predictions. Outcome measures included neurological function, as assessed by the Hoffmann grading system, and complications such as wound dehiscence and cerebrospinal fluid leakage.
Results:
The dorsal LSLs demonstrated a 62.5% total resection rate with 37.5% symptomatic improvement after surgery. The caudal LSLs demonstrated a lower total resection rate (46.15%), with 30.77% of the patients experiencing symptom worsening. Transitional LSLs demonstrated a 100% positive outcome after total resection. Chaotic LSLs, the most complex LSL, had a postoperative deterioration rate of 40% after subtotal resection. Overall, surgical complications were noted in 17.8% of the patients.
Conclusion:
Surgical management of symptomatic pediatric patients with LSL yields significant benefits, with a careful balance between radical resection and preservation of neurological function. The type of lipoma significantly influences surgical planning and outcomes. Despite challenges in achieving complete resection in chaotic LSLs, tailored surgical approaches based on preoperative imaging and lipoma classification can optimize patient outcomes.
