Aggressive resection of congenital lumbosacral lipomas in adults: indications, techniques and outcomes in 122 patients.

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Aggressive resection of congenital lumbosacral lipomas in adults: indications, techniques and outcomes in 122 patients.

World Neurosurg. 2018 Jan 11;:

Authors: Bai SC, Tao BZ, Wang LK, Yu XG, Xu BN, Shang AJ

Abstract
OBJECTIVE: The authors reviewed the treatment of adult patients with congenital intraspinal lipomas with total/near-total resection and discussed their preoperative characteristics, prognostic factors and surgical outcomes.
METHODS: Medical records of 122 adult patients with congenital lumbosacral lipomas undergoing total/near-total resection were systematically analyzed. The cohort was subdivided into three groups depending on symptom onset age: Group 1 (≤5 years, n = 40), Group 2 (＞5 years but ＜18 years, n = 33), and Group 3 (＞18 years, n = 49). Pre- and postoperative neurological status were compared between groups and analyzed as a whole.
RESULTS: The most common symptom was bladder dysfunction (82.0%), followed by constipation (76.2%). At the 3-month follow-up, improvement was noted in the majority of patients presenting with pain (87.2%) and neuropathic ulcers (70.0%). Overall, neurological status was improved in 73.0% of patients and stabilized in 19.7% of patients. A binary logistic regression model identified shorter preoperative duration (p = 0.013) and preoperative pain (p = 0.005) as independent predictors of postoperative improvement. Neurosurgical complications developed in 16 patients, and wound complications occurred in 2 patients. Two out of three patients who had recurred symptoms underwent repeated detethering surgery during long-term follow-up.
CONCLUSION: Despite longer preoperative duration than the pediatric population, adult patients with lumbosacral lipomas can still benefit from total/near-total resection especially regarding pain and foot ulcers, with a low surgical-related morbidity rate. The long-term advantage of resecting additional lipoma in adults remains a point of discussion.

PMID: 29337168 [PubMed - as supplied by publisher]

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