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Effect of surgical repair on the neurologic function in infants with lipomeningocele
1Department of Neurosurgery, Children's Hospital, Boston, MA 02115.
Insights
Early surgery for infants with lipomeningocele may reverse abnormal urinary tract function. Prophylactic surgical intervention showed improved urodynamic studies and neurological outcomes in young patients.
Area of Science:
- Pediatric Neurosurgery
- Urology
- Developmental Biology
Background:
- Lipomeningocele is a congenital condition affecting spinal cord development.
- Urinary tract dysfunction is a common complication in infants with lipomeningocele.
Purpose of the Study:
- To evaluate the impact of early prophylactic surgery on neuro-urological outcomes in infants with lipomeningocele.
- To assess the reversibility of abnormal urinary tract function following surgical intervention.
Main Methods:
- Retrospective review of 18 infants under 1 year old treated for lipomeningocele between 1983 and 1991.
- Pre- and postoperative neurological examinations and urodynamic studies (UDS), including cystometrogram and external urethral sphincter electromyography.
- Surgical procedures involved spinal cord untethering, laser debulking of lipoma, and dural grafting.
Main Results:
- Two of 10 infants with normal neurological exams had abnormal preoperative UDS.
- Early surgery normalized abnormal preoperative UDS in 83% (5/6) of infants.
- 38% (3/8) of infants with abnormal neurological exams improved postoperatively, with no worsening observed.
Conclusions:
- Early prophylactic surgery for lipomeningocele in infants may lead to the normalization of abnormal urinary tract function.
- Surgical intervention shows potential for improving neurological status in affected infants.
- These findings suggest that timely surgical management can positively impact neuro-urological outcomes in pediatric lipomeningocele cases.
Abstract:
Eighteen children under the age of 1 year underwent surgery for lipomeningocele at our institution between 1983 and 1991. All the patients had neurologic exams and urodynamic studies (UDS) including a cystometrogram and electromyography of the external urethral sphincter pre- and postoperatively. The surgical procedure performed included an untethering of the spinal cord, laser debulking of the lipoma and placement of a dural graft. All the infants presented with a lesion on their back. Two of 10 infants with a normal neurological exam had abnormal UDS preoperatively. Early surgery normalized abnormal preoperative UDS in 5 of 6 (83%) infants with abnormal UDS. Moreover, 3 of 8 (38%) infants with an abnormal neurological exam preoperatively improved after surgery and none worsened. These observations suggest that abnormal urinary tract function in infants with lipomeningocele may be reversible with early prophylactic surgery.