Surgical treatment of spinal lipomatous malformations

Abstract

The value of early surgery in spinal lipomatous malformations has not been proved. This paper presents the results of surgical treatment performed immediately after detection in 11 patients presenting with three different groups of malformations: intramedullary lipomas—two patients, conus medullaris lipomas—seven patients, and filum lipomas—two patients. The diagnostic work-up included MRI, CT and spinal X-rays, and functionally the patients were investigated with SSEP and urodynamic tests. The surgical technique for the intramedullary lesions was partial debulking, and total microsurgical excision was performed on filum lipoma patients. Conus lipomas were managed by partial excision, with an emphasis on: (1) dissection of the malformative cord beginning from the normal area; (2) debulking of the lesion without approaching the conus–fat interface to make reconstruction of the conus with pial approximation possible; and (3) redundant dural sac reconstruction. The results are analyzed in view of the technique applied, and after a follow-up ranging from 9 months to 4 years, no significant early complications were observed in the conus medullaris lipomas group. The other two groups showed the predictable results, arrest of deterioration in the intramedullary lipomas and an excellent outcome for the filum lipoma patients.