Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지
DOI QR코드

DOI QR Code

Surgical Management of Complex Spinal Cord Lipomas : A New Perspective

  • Pang, Dachling (Department of Paediatric Neurosurgery, Great Ormond Street Hospital for Children, NHS Trust)
  • Received : 2020.01.28
  • Accepted : 2020.04.28
  • Published : 2020.05.01
Download PDF
⟨ Previous Next ⟩

Abstract

This review summarises the classification, anatomy and embryogenesis of complex spinal cord lipomas, and describes in some detail the new technique of total lipoma resection and radical reconstruction of the affected neural placode. Its specific mission is to tackle two main issues surrounding the management of complex dysraphic lipomas : whether total resection confers better long term benefits than partial resection, and whether total resection does better than conservative treatment, i.e., no surgery, for asymptomatic lipomas. Accordingly, the 24 years progression-free survival data of the author and colleagues' series of over 350 cases of total resection are compared with historical data from multiple series (including our own) of partial resection, and total resection data specifically for asymptomatic lesions are compared with the two known series of non-surgical treatment of equivalent patients. These comparisons amply support the author's recommendation of total resection for most complex lipomas, with or without symptoms. The notable exception is the asymptomatic chaotic lipoma, whose peculiar anatomical relationship with the neural tissue defies even our aggressive surgical approach, and consequently projects worse results (admittedly of small number of cases) than for the other two lipoma subtypes of dorsal and transitional lesions. Prophylactic resection of asymptomatic chaotic lipomas is therefore not currently endorsed.

Keywords

References

  1. Arai H, Sato K, Wachi A : Surgical management in 81 patients with congenital intraspinal lipoma. Child Nerv Syst 8 : 171, 1992
  2. Atala A, Bauer SB, Dyro FM, Shefner J, Shillito J, Sathi S, et al. : Bladder functional changes resulting from lipomyelomeningocele repair. J Urol 148(2 Pt 2) : 592-594, 1992 https://doi.org/10.1016/S0022-5347(17)36662-4
  3. Barson AJ : The vertebral level of termination of the spinal cord during normal and abnormal development. J Anat 106(Pt 3) : 489-497, 1970
  4. Bruce DA, Schut L : Spinal lipomas in infancy and childhood. Childs Brain 5 : 192-203, 1979
  5. Brunelle F, Sebag G, Baraton J, Carteret M, Martinat P, Pierre-Kahn A : Lumbar spinal cord motion measurement with phase-contrast MR imaging in normal children and in children with spinal lipomas. Pediatr Radiol 26 : 265-270, 1996 https://doi.org/10.1007/BF01372108
  6. Byrne RW, Hayes EA, Georg TM, McLone DG : Operative resection of 100 spinal lipomas in infants less than 1 year of age. Pediatr Neurosurg 23 : 182-186; discussion 186-187, 1995 https://doi.org/10.1159/000120956
  7. Caldarelli M, McLone DG, Colins JA, Suwa J, Knepper PA : Vitamin A induced neural tube defects in a mouse. Concepts Pediatr Neurosurg 6 : 161-171, 1985
  8. Chapman PH : Congenital intraspinal lipomas: anatomic considerations and surgical treatment. Childs Brain 9 : 37-47, 1982
  9. Chapman PH, Davis KR : Surgical treatment of spinal lipomas in childhood. Pediatr Neurosurg 19 : 267-275; discussion 274, 1993 https://doi.org/10.1159/000120743
  10. Cochrane DD, Finley C, Kestle J, Steinbok P : The patterns of late deterioration in patients with transitional lipomyelomeningocele. Eur J Pediatr Surg 10 Suppl 1 : 13-17, 2000 https://doi.org/10.1055/s-2008-1072406
  11. Colak A, Pollack IF, Albright AL : Recurrent tethering: a common longterm problem after lipomyelomeningocele repair. Pediatr Neurosurg 29 : 184-190, 1998 https://doi.org/10.1159/000028719
  12. Cornette L, Verpoorten C, Lagae L, Plets C, Van Calenbergh F, Casaer P : Closed spinal dysraphism: a review on diagnosis and treatment in infancy. Eur J Paediatr Neurol 2 : 179-185, 1998 https://doi.org/10.1016/S1090-3798(98)80017-2
  13. Detwiler SR, Hotzer H : The inductive and formative influence of the spinal cord upon the vertebral column. Bull Hosp Joint Dis 15 : 114-123, 1954
  14. Dias M, Pang D : Human neural embryogenesis: a description of neural morphogenesis and a review of embryonic mechanisms in Pang D (ed) : Disorders of the Pediatric Spine. New York : Raven Press, 1994
  15. Dick EA, de Bruhn R : Ultrasound of the spinal cord in children: its role. Eur Radiol 13 : 552-562, 2003 https://doi.org/10.1007/s00330-002-1655-0
  16. Dorward NL, Scatliff JH, Hayward RD : Congenital lumbosacral lipomas: pitfalls in analysing the results of prophylactic surgery. Childs Nerv Syst 18 : 326-332, 2002 https://doi.org/10.1007/s00381-002-0624-x
  17. Hamilton HL, Boyd JD, Mossman HM : Human Embryology, ed 4. Baltimore : Williams & Wilkins, 1972
  18. Hoffman HJ, Hendrick EB, Humphreys RP : The tethered spinal cord: its protean manifestations, diagnosis and surgical correction. Childs Brain 2 : 145-155, 1976
  19. Hoffman HJ, Taecholarn C, Hendrick EB, Humphreys RP : Management of lipomyelomeningoceles. Experience at the Hospital for Sick Children, Toronto. J Neurosurg 62 : 1-8, 1985 https://doi.org/10.3171/jns.1985.62.1.0001
  20. James CC, Lassman LP : Diastematomyelia and the tight filum terminale. J Neurol Sci 10 : 193-196, 1970 https://doi.org/10.1016/0022-510X(70)90019-5
  21. James HE, Canty TG : Human tails and associated spinal anomalies. Clin Pediatr (Phila) 34 : 286-288, 1995 https://doi.org/10.1177/000992289503400516
  22. James HE, Williams J, Brock W, Kaplan GW, U HS : Radical removal of lipomas of the conus and cauda equina with laser microneurosurgery. Neurosurgery 13 : 340-345, 1984 https://doi.org/10.1227/00006123-198309000-00026
  23. Jones PH, Love JG : Tight filum terminale. AMA Arch Surg 73 : 556-566, 1956 https://doi.org/10.1001/archsurg.1956.01280040010002
  24. Kallen B : Early embryogenesis of the central nervous system with special reference to closure defects. Dev Med Child Neurol 10(Suppl 6) : 44-53, 1968 https://doi.org/10.1111/j.1469-8749.1968.tb04846.x
  25. Kanev PM, Lemire RJ, Loeser JD, Berger MS : Management and longterm follow-up review of children with lipomyelomeningocele, 1952-1987. J Neurosurg 74 : 48-52, 1990
  26. Koyanagi I, Iwasaki Y, Hida K, Abe H, Isu T, Akino M : Surgical treatment supposed natural history of the tethered cord with occult spinal dysraphism. Childs Nerv Syst 13 : 268-274, 1997 https://doi.org/10.1007/s003810050081
  27. Kulkarni AV, Pierre-Kahn A, Zerah M : Conservative Management of asymptomatic spinal lipomas of the conus. Neurosurgery 54 : 868-873; discussion 873-875, 2004 https://doi.org/10.1227/01.NEU.0000114923.76542.81
  28. Kunitomo K : The development and reduction of the tail and of the caudal end of the spinal cord. Carnegie Contr Embryol 8 : 161-203, 1918
  29. La Marca F, Grant JA, Tomita T, McLone DG : Spinal lipomas in children: Outcome of 270 procedures. Pediatr Neurosurg 26 : 8-16, 1997 https://doi.org/10.1159/000121155
  30. Marin-Padilla M : Clinical and experimental rachischisis in Vinken PS, Bruyn GW (eds) : Handbook of clinical neurology. Amsterdam : North-Holland, 1978, Vol 32, pp159-191
  31. Marin-Padilla M : Mesodermal alterations induced by hypervitaminosis A. J Embryol Exp Morphol 15 : 261-269, 1966
  32. Marin-Padilla M : Morphogenesis of anencephaly and related malformations in Current topics in pathology. Heidelberg : Springer, 1921, pp145-174
  33. Marin-Padilla M : Morphogenesis of experimental encephalocele (Cranioschisis occulta). J Neurol Sci 46 : 83-99, 1980 https://doi.org/10.1016/0022-510X(80)90045-3
  34. Marin-Padilla M : Notochordal-basichondrocranium relationships: abnormalities in experimental axial skeletal (dysraphic) disorders. J Embryol Exp Morphol 53 : 15-38, 1979
  35. Marin-Padilla M : The tethered cord syndrome: developmental considerations in Holtzmann RNN, Stein BM (eds) : The tethered spinal cord. New York : Thieme, 1985, pp3-13
  36. Marin-Padilla M, Marin-Padilla TM : Morphogenesis of experimentally induced Arnold--Chiari malformation. J Neurol Sci 50 : 29-55, 1981 https://doi.org/10.1016/0022-510X(81)90040-X
  37. McGuire EJ, Woodside JR, Borden TA, Weiss RM : Prognostic value of urodynamic testing in myelodysplastic patients. J Urol 126 : 205-209, 1981 https://doi.org/10.1016/S0022-5347(17)54449-3
  38. McGuire EJ : The innervation and function of the lower urinary tract. J Neurosurg 65 : 278-285, 1986 https://doi.org/10.3171/jns.1986.65.3.0278
  39. McLone DG, Knepper PA : Role of complex carbohydrates and neurulation. Pediatr Neurosci 1 : 2-9, 1985-1986 https://doi.org/10.1159/000120211
  40. McLone DG, Mutluer S, Naidich TP : Lipomeningoceles of the conus medullaris in Karger S (ed) : Concepts in Pediatric Neurosurgery. Basel : Karger, 1982, pp171-177
  41. McLone DG, Naidich TP : Laser resection of fifty spinal lipomas. Neurosurgery 18 : 611-615, 1986 https://doi.org/10.1227/00006123-198605000-00016
  42. McLone DG, Naidich TP : Spinal dysraphism: Experimental and clinical in Holtzman RN, Stein BM (eds) : The Tethered Spinal Cord. New York : Thieme-Stratton, 1985
  43. McLone DG, Suwa J, Collins JA, Poznaski S, Knepper PA : Neurulation: biochemical and morphological studies on primary and secondary neural tube defects. Concepts Pediatr Neurosurg 4 : 15-29, 1983
  44. Morriss-Kay GM, Crutch B : Culture of rat embryos with beta-D-xyloside: evidence of a role for proteoglycans in neurulation. J Anat 134(Pt 3) : 491-506, 1982
  45. Muller F, O'Rahilly R : The development of the human brain, the closure of the caudal neuropore, and the beginning of secondary neurulation at Stage 12. Anat Embryol (Berl) 176 : 413-430, 1987 https://doi.org/10.1007/BF00310083
  46. O'Rahilly R, Meyer DB : The timing and sequence of events in the development of the human vertebral column during the embryonic period proper. Anat Embryol (Berl) 157 : 167-176, 1979 https://doi.org/10.1007/BF00305157
  47. O'Shea KS, Kaufman MH : Phospholipase C-induced neural tube defects in the mouse embryo. Experientia 36 : 1217-1219, 1980 https://doi.org/10.1007/BF01976138
  48. Pang D : Commentary to the article: asymptomatic lumbosacral lipomas-a natural history study, by Wykes V, Desai D, and Thompson DNP. Childs Nerv Syst 28 : 1741-1742, 2012 https://doi.org/10.1007/s00381-012-1808-7
  49. Pang D : Electrophysiological monitoring for tethered cord surgery in Yamada S (ed) : Tethered cord syndrome, ed 2. New York : Thieme Medical Publishers, 2010, pp199-209
  50. Pang D : Intraoperative neurophysiology of the conus medullaris and cauda equina. Childs Nerv Syst 26 : 411-412, 2010 https://doi.org/10.1007/s00381-010-1112-3
  51. Pang D : Spinal Cord Lipoma in Batjer H, Loftus C (eds) : Textbook of Neurological Surgery. New Jersey : Lippincott, Williams and Wilkins, 2002
  52. Pang D : Spinal Cord Lipomas in Pang D (ed) : Disorders of the Pediatric Spine. New York : Raven Press, 1995, pp175-201
  53. Pang D : Surgical management of complex spinal cord lipomas: how, why, and when to operate. A review. J Neurosurg Pediatr 23 : 537-556, 2019 https://doi.org/10.3171/2019.2.PEDS18390
  54. Pang D : Tethered Cord Syndrome in Hoffman HJ (ed) : Advances in Pediatric Neurosurgery. Philadelphia : Hanley and Belfus, Inc, 1986, pp45-79
  55. Pang D : Total resection of complex spinal cord lipomas: how, why, and when to operate? Neurol Med Chir (Tokyo) 55 : 695-721, 2015 https://doi.org/10.2176/nmc.ra.2014-0442
  56. Pang D, Casey K : Use of an anal sphincter pressure monitor during operations on the sacral spinal cord and nerve roots. Neurosurgery 13 : 562-568, 1983 https://doi.org/10.1227/00006123-198311000-00013
  57. Pang D, Wilberger JE Jr : Tethered cord syndrome in adults. J Neurosurg 57 : 32-47, 1982 https://doi.org/10.3171/jns.1982.57.1.0032
  58. Pang D, Zovickian J, Moes GS : Retained medullary cord in humans: late arrest of secondary neurulation. Neurosurgery 68 : 1500-1519; discussion 1519, 2011 https://doi.org/10.1227/NEU.0b013e31820ee282
  59. Pang D, Zovickian J, Oviedo A : Long-term outcome of total and neartotal resection of spinal cord lipomas and radical reconstruction of the neural placode: part I-surgical technique. Neurosurgery 65 : 511-528; discussion 528-529, 2009 https://doi.org/10.1227/01.NEU.0000350879.02128.80
  60. Pang D, Zovickian J, Oviedo A : Long-term outcome of total and neartotal resection of spinal cord lipomas and radical reconstruction of the neural placode, part II: outcome analysis and preoperative profiling. Neurosurgery 66 : 253-272; discussion 272-273, 2010 https://doi.org/10.1227/01.NEU.0000363598.81101.7B
  61. Pang D, Zovickian J, Wong ST, Hou YJ, Moes GS : Surgical treatment of complex spinal cord lipomas. Childs Nerv Syst 29 : 1485-1513, 2013 https://doi.org/10.1007/s00381-013-2187-4
  62. Pierre-Kahn A, Lacombe J, Pichon J, Giudicelli Y, Renier D, Sainte-Rose C, et al. : Intraspinal lipomas with spina bifida. Prognosis and treatment in 73 cases. J Neurosurg 65 : 756-761, 1986 https://doi.org/10.3171/jns.1986.65.6.0756
  63. Pierre-Kahn A, Zerah M, Renier D, Cinalli G, Sainte-Rose C, Lellouch-Tubiana A, et al. : Congenital lumbosacral lipomas. Childs Nerv Syst 13 : 298-334; discussion 335, 1997 https://doi.org/10.1007/s003810050090
  64. Sathi S, Madsen JR, Bauer S, Scott RM : Effect of surgical repair on the neurologic function in infants with lipomeningocele. Pediatr Neurosurg 19 : 256-259, 1993 https://doi.org/10.1159/000120741
  65. Schoenwolf GC : Histological and ultrastructural observations of tail bud formation in the chick embryo. Anat Rec 193 : 131-147, 1979 https://doi.org/10.1002/ar.1091930108
  66. Schoenwolf GC : Histological and ultrastructural studies of secondary neurulation in mouse embryos. Am J Anat 169 : 361-376, 1984 https://doi.org/10.1002/aja.1001690402
  67. Schut L, Bruce DA, Sutton LN : The management of the child with a lipomyelomeningocele. Child Neurosurg 30 : 464-476, 1983 https://doi.org/10.1093/neurosurgery/30.CN_suppl_1.464
  68. Stolke D, Zumkeller M, Seifert V Intraspinal lipomas in infancy and childhood causing a tethered cord syndrome. Neurosurg Rev 11 : 59-65, 1988 https://doi.org/10.1007/BF01795696
  69. Streeter GL : Factors involved in the formation of the filum terminale. Am J Anat 25 : 1-11, 1919 https://doi.org/10.1002/aja.1000250102
  70. Sutton LN : Lipomyelomeningocele. Neurosurg Clin N Am 6 : 325-338, 1995 https://doi.org/10.1016/S1042-3680(18)30466-2
  71. Talwalker VC, Datsur DK : Ectopic spinal cord myelomeningocele with tethering: a clinicopathological entity. Dev Med Child Neurol 16 (Suppl 32) : 159-160, 1974
  72. Toole BP : Glycosaminoglycans in morphogenesis in Hay E (ed) : Cell Biology of Extracellular Matrix. New York : Plenum Press, 1981, pp229-294
  73. Wykes V, Desai D, Thompson DN : Asymptomatic lumbosacral lipomas-a natural history study. Childs Nerv Syst 28 : 1731-1739, 2012 https://doi.org/10.1007/s00381-012-1775-z
  74. Xenos C, Sgouros S, Walsh R, Hockley A : Spinal lipomas in children. Pediatr Neurosurg 32 : 295-307, 2000 https://doi.org/10.1159/000028958

Cited by

  1. Ultrasound of congenital spine anomalies vol.51, pp.13, 2021, https://doi.org/10.1007/s00247-021-05178-6