Surgical techniques of sacrococcygeal spinal cord lipomas

Abstract

Objective To introduce the pathological anatomies and surgical techniques of sacrococcygeal spinal cord lipomas.Methods Data was collected on 119 patients with sacrococcygeal spinal cord lipomas at Shanghai Children's Medical Center from September 2005 to January 2012,ages 1 month to 18 years,whose neurological symptoms included incontinence of urine and stool and/or malfunction of the lower extremities.The surgical procedures consisted of the excision of subcutaneous and intradural extramedullary lipoma,partial excision of the intramedullary lipoma,detachment of the spinal cord from the dural membrane,freeing the conus medullaris from the end of the dura sac,and relief of the tethered spinal cord.Results The main pathological changes of sacrococcygeal spinal cord lipomas were similar to those of the lumbosacral ones.The differences included that the conus medullaris growed with the end of dura sac,the spinal nerves of the conus medullaris originated from its ventral part and ran obliquely and inferiorly,the lipoma is located within the conus medullaris and beyond the spinal nerves below the conus medullaris.108cases were followed up for 0.5 to 7.0 years.Improvement after surgery varied amongst the symptomatic patients.The symptoms in 1 case worsened after surgery,transient deterioration of symptoms after surgery were seen in 6 cases,9 out of 10 asymptomatic patients remained asymptomatic while the rest showed transient deterioration of symptoms.Conclusions We could optimally excise the lipoma,untether the spinal cord and avoid damage to the spinal nerves,reconstruct the normal anatomy of the spinal cord,and rehabilitate neurological functions with the thorough understanding of the pathology of the sacrococcygeal spinal cord lipomas. Key words: Spinal cord lipoma; Pathology; Surgery; Tethered spinal cord