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Operative resection of 100 spinal lipomas in infants less than 1 year of age
R W Byrne1, E A Hayes, T M George
1Department of Neurosurgery, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Ill., USA.
Insights
Early surgery for spinal lipomas in infants, focusing on spinal cord untethering, is safe and effective. Cosmetic-only procedures can lead to deterioration, while untethering improves outcomes compared to natural disease progression.
Area of Science:
- Pediatric Neurosurgery
- Spinal Cord Surgery
- Congenital Anomalies
Background:
- Spinal lipomas are congenital tumors requiring surgical intervention.
- The optimal surgical approach and timing for spinal lipomas remain subjects of investigation.
- Untethering the spinal cord is a critical component of surgical management.
Purpose of the Study:
- To evaluate the safety and efficacy of surgical interventions for spinal lipomas in children.
- To compare outcomes between untethering and cosmetic-only procedures.
- To identify risk factors for delayed postoperative deterioration.
Main Methods:
- Retrospective analysis of 100 pediatric patients with spinal lipomas.
- Mean follow-up duration of 5 years.
- Categorization of surgeries into untethering and cosmetic procedures.
Main Results:
- Untethering surgery in the first year of life was safe and effective.
- Cosmetic-only procedures were associated with delayed symptomatic tethered cord.
- Symptomatic infants showed improvement (39%) or stabilization (58%) post-untethering.
- Asymptomatic infants undergoing untethering had excellent outcomes (93% symptom-free).
- Lipomyelomeningocele, preoperative symptoms, and cosmetic procedures were risk factors for deterioration.
Conclusions:
- Early spinal cord untethering for spinal lipomas offers superior outcomes compared to natural history.
- Surgical goals should prioritize spinal cord untethering over cosmetic debulking.
- Identifying and mitigating risk factors can improve surgical results in pediatric spinal lipoma cases.
Abstract:
A retrospective analysis of 100 children followed at Children's Memorial Hospital, Chicago, who underwent surgery for a spinal lipoma was performed. The mean follow-up was 5 years. We found that an operation performed during the 1st year of life with the goal of untethering the spinal cord and debulking the spinal lipoma was safe and effective, whereas a cosmetic (nonuntethering) procedure always led to delayed postoperative deterioration (symptomatic tethered cord). Of the infants that presented with motor, urologic or orthopedic symptoms, 39% improved, 58% stabilized, while 3% worsened as a result of surgery. No asymptomatic infant deteriorated postoperatively and 93% of these children remained symptom-free at follow-up (mean follow-up was 44 months). The overall outcome of infants after untethering procedures in this study was significantly better than the natural history of spinal lipomas. Several risk factors were identified that may predispose children to delayed postoperative deterioration: an initial cosmetic procedure; the presence of preoperative symptoms, and the presence of a lipomyelomeningocele.