Microsurgical treatment of lumbosacral lipoma with tethered cord syndrome

Abstract

Objective To investigate the classification and microsurgical treatment effect of the combined lumbosacral lipoma with tethered cord syndrome.Methods A retrospective analysis of 39 children patients suffered from lumbosacral lipoma and tethered spinal cord disease in neurosurgery department of the First Affiliated Hospital of Harbin Medical University from May 2008 to July 2011 was performed.According to the preoperative MRI features and intraoperative anatomy characteristics,the patients were divided into the dorsal,transitional,and chaotic lipomas.Under general anesthesia,the microscope lipoma resection and spinal neurolysis cut wire surgery were performed.The children Hoffman functional classification were carried out at one week before surgery and three months after surgery to compare the treatment effects.Results All 39 patients were followed up,with an average of fifteen months,no deaths,12 cases of dorsal lipomas and 18 transitional lipomas were improved or stable after surgery,no neurological deficit increase,the results were satisfactory.9 chatic lipomas were improved or stable after surgery compared with preoperative symptoms,but 2 patients′ incontinence got worse.Two cases occurred cerebrospinal fluid leakage postoperative,one transitional case and one chaotic case,were subject to stringent anti-inflammatory treatment to be healed.Conclusions For the lumbosacral dosal and transitional lipoma either with or without neurological deficit early,as early as possible under the microscope have advocate resection of spinal cord lipoma release the final wire off the surgery;but for the chaotic lipomas,surgery are difficult to fully identify the cauda equina and filum terminale,the symptoms impoved after surgery is not ideal,more compilications,early operation should be carefully considered.