Management of Lumbosacral Lipomas

Abstract

Congenital lumbosacral lipomas are the most common form of occult spinal dysraphism. They are part of a loco-regional malformation involving almost always the skin, the spine and the nervous tissue. The most characteristic neural anomaly is a low-lying cord. These lipomas are diagnosed usually pre- or immediately post-natally. A few, however, are seen later on during childhood or adulthood, because of evolving sensory-motor, sphincterian or orthopedic deterioration. In 1950, Basset proposed [1] to operate on asymptomatic patients to prevent them from late deterioration. This concept of preventive surgery became the gold standard of treatment after the publications in 1981 of James and Lassman [5] and of Yamada [9] who demonstrated the development of neuronal dysfunction in response to acute stretching of the terminal cord on rats. Recently, however, prophylactic surgery was questioned [7] at least for lipomas of the conus and, now, a growing number of pediatric neurosurgeons would not operate any more on asymptomatic patients [2, 3, 4, 8, 10], estimating that surgery is risky and does not modify the natural history of the malformation.