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DOI: 10.1055/s-0032-1324692
Pathological Changes and Surgical Treatment of Lipomas of the Conus Medullaris
Publikationsverlauf
22. März 2012
25. Juni 2012
Publikationsdatum:
23. Oktober 2012 (online)
![](https://www.thieme-connect.de/media/ejps/201302/lookinside/thumbnails/10.1055-s-0032-1324692-1.jpg)
Abstract
Objective To describe the pathological changes of lipomas of the conus medullaris and the appropriate surgical treatment for removing such lipomas for optimal reconstruction of the normal spinal cord anatomy.
Methods Data were collected on 73 patients, aged 1.5 months to 18 years, who underwent surgical removal of a lipoma of the conus medullaris at Shanghai Children's Medical Center from January 2005 to December 2008. Neurological symptoms included pain, urine and stool incontinence, and bilateral lower limb dysfunction. The surgical procedures consisted of excision of subcutaneous and intradural extramedullary lipoma, partial excision of intramedullary lipoma, detachment of the spinal cord from the dural membrane, relief of tethered spinal cord, and excision of the affected filum terminale.
Results The main pathological changes in patients with lipoma of the conus medullaris were ventral deviation of the spinal cord caused by compression from a dorsal lipoma, traction on the spinal cord from attachment of intradural lipoma and subcutaneous lipoma, increased tight fit between the spinal cord and the dural membrane on both sides, and degeneration of the filum terminale. A total of 67 patients were followed up for 6 months to 4 years. Improvement after surgery varied among the symptomatic patients. A total of 5 patients had transient deterioration of symptoms after surgery. All asymptomatic patients remained asymptomatic.
Conclusion Only through thorough understanding of the pathology of the lipoma of the conus medullaris, we could optimally excise the lipoma, untether the spinal cord, reconstruct the normal anatomy of the spinal cord, and rehabilitate neurological function.
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References
- 1 Anderson FM. Occult spinal dysraphism: a series of 73 cases. Pediatrics 1975; 55 (6) 826-835
- 2 Arai H, Sato K, Okuda O , et al. Surgical experience of 120 patients with lumbosacral lipomas. Acta Neurochir (Wien) 2001; 143 (9) 857-864
- 3 Bruce DA, Schut L. Spinal lipomas in infancy and childhood. Childs Brain 1979; 5 (3) 192-203
- 4 Chapman PH. Congenital intraspinal lipomas: anatomic considerations and surgical treatment. Childs Brain 1982; 9 (1) 37-47
- 5 Hall WA, Albright AL, Brunberg JA. Diagnosis of tethered cords by magnetic resonance imaging. Surg Neurol 1988; 30 (1) 60-64
- 6 La Marca F, Grant JA, Tomita T, McLone DG. Spinal lipomas in children: outcome of 270 procedures. Pediatr Neurosurg 1997; 26 (1) 8-16
- 7 Pierre-Kahn A, Zerah M, Renier D , et al. Congenital lumbosacral lipomas. Childs Nerv Syst 1997; 13 (6) 298-334 , discussion 335
- 8 Tortori-Donati P, Rossi A, Cama A. Spinal dysraphism: a review of neuroradiological features with embryological correlations and proposal for a new classification. Neuroradiology 2000; 42 (7) 471-491
- 9 Colak A, Pollack IF, Albright AL. Recurrent tethering: a common long-term problem after lipomyelomeningocele repair. Pediatr Neurosurg 1998; 29 (4) 184-190
- 10 Finn MA, Walker ML. Spinal lipomas: clinical spectrum, embryology, and treatment. Neurosurg Focus 2007; 23 (2) E10
- 11 Wilkins RH, Rengachary SS , eds. Neurosurgery Update II: Spinal, Pediatric, and Functional Neurosurgery. New York, NY: McGraw-Hill; 1991
- 12 Herman JM, McLone DG, Storrs BB, Dauser RC. Analysis of 153 patients with myelomeningocele or spinal lipoma reoperated upon for a tethered cord. Presentation, management and outcome. Pediatr Neurosurg 1993; 19 (5) 243-249
- 13 Sutton LN. Lipomyelomeningocele. Neurosurg Clin N Am 1995; 6 (2) 325-338
- 14 Xenos C, Sgouros S, Walsh R, Hockley A. Spinal lipomas in children. Pediatr Neurosurg 2000; 32 (6) 295-307
- 15 Blount JP, Elton S. Spinal lipomas. Neurosurg Focus 2001; 10 (1) e3
- 16 Pierre-Kahn A, Lacombe J, Pichon J , et al. Intraspinal lipomas with spina bifida. Prognosis and treatment in 73 cases. J Neurosurg 1986; 65 (6) 756-761
- 17 Souweidane MM, Drake JM. Retethering of sectioned fibrolipomatous filum terminales: report of two cases. Neurosurgery 1998; 42 (6) 1390-1393
- 18 McLone DG , ed. Pediatric Neurosurgery: Surgery of the Developing Nervous System. Philadelphia, PA: WB Saunders; 2001
- 19 McLone DG , ed. Pediatric Neurosurgery: Surgery of the Developing Nervous System. Philadelphia, PA: WB Saunders; 2001
- 20 Kanev PM, Bierbrauer KS. Reflections on the natural history of lipomyelomeningocele. Pediatr Neurosurg 1995; 22 (3) 137-140