Subject Area
Neurosurgery
Article Type
Original Study
Abstract
Background: management of spinal lipomas is considered a challenging task for pediatric neurosurgeons. Study Design: A prospective, clinical study. Objectives: To assess the neurological outcomes after surgical resection of spinal lipomas. Patients and methods: The study was performed on 30 patients, underwent surgical resection of spinal cord lipomas. The cases were followed up post-operatively in the outpatient clinic for at least 24 months. Results; This study included 30 patients with spinal lipomas (12 boys and 18 girls) with age of less than two years at surgery. At presentation, all the 30 cases had low back swelling.19 (63.3%) with bladder dysfunction, of whom 14 (73.7%) had incomplete dysfunction, while 5(26.3%) had complete dysfunction. 16 cases (53.3%) had motor weakness. Two cases (6.6%) presented by orthopedic deformities. All 30 cases had no previous surgery for spinal lipoma. Three types of spinal lipomas were detected in pre-operative magnetic resonance image (MRI); transitional (n = 24), dorsal (n = 5), caudal (n = 1). Excision of lipoma was near total in 21(70%) cases and subtotal in 9 (30%) cases. Post-operative Complications; cerebro-spinal fluid (CSF) leakage in 5 (16.6%) cases, wound infection in 4 (13.3%).Early outcome: Two cases (6.6%) acquired a new but transient motor deficit. Out of the 16 patients who experienced pre-operative motor weakness; 13 (81.3%) patients improved whereas 3 (18.7 %) cases got. Incomplete bladder dysfunction was regained in 9 (64.3%) patients, while only one patient (7.1%) progressed to have complete dysfunction (out of 14 patients). None of the patients with complete bladder dysfunction showed improvement. Long-term outcomes: Out of the 16 patients who presented with pre-operative motor weakness, 11 (68.7%) patients had improved, while 5 (31.3%) patients developed worsening (p < 0.001). Concerning the bladder function; 9 (81.9%) of the 11 patients with normal pre-operative bladder function maintained normal, while worsening of bladder function was noted in 2 (18.1%) patients. All the patients with pre-operative complete bladder dysfunction remained on CIC, while in 13(92.9%) of 14 patients with incomplete bladder dysfunction, normal bladder function was regained and only one case developed worsening (p < 0.001). i.e. the untethering surgery resulted in significant improvement in the pre-operative neurological deficits (motor and urological), as a p values < 0.001. On long-term follow-up of our patients, five (16.7%) patients developed symptomatic re-tethering (neurological deterioration), and underwent partial excision of spinal lipomas. The mean time interval from appearance of first symptom and surgery in those who improved was 10 months (range, 4 - 18 months), whereas in those who did not improve it was 16 months (range, 10 to 24 months) with p < 0.001, indicating the beneficial role of early surgery. Conclusion: Better long-term neurological outcomes could be achieved after near-total than partial excision of spinal lipomas.
Recommended Citation
El Sakhry, Ramy Omar Omar; Badr, Hatem Ibrahim; Abdel-Aal, Ibrahim El Sayd Ahmed; and Khalil, Amr Farid
(2023)
"Spinal cord lipomas in children: surgical resection and outcome,"
Mansoura Medical Journal: Vol. 52
:
Iss.
2
, Article 2.
Available at:
https://doi.org/10.58775/2735-3990.1375
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.
