At What Age Surgery of Patients with Spinal Lipoma?

Overview

The authors present two case-reports of spinal lipomas, which belong among closed neural tu be defects. Theaim of the study is to point out the role of age at the time of surgical intervention.Some of the clinical signs were the same in both patients studied. In neonatal age the only symptom of congenitalanomaly was skin malformation in the midline of the lumbosacral region without deterioration of neurologicalfunction. Changes of this function, resulting from the tethered spinal cord, appeared later and progressed. Onlythen was the exact diagnosis established and surgery performed. MRI, operative and histological findingsconfirmed a nearly identical type of malformation. From the split conical end of the spinal cord, which was ina lower position, a lipoma arose with no extension to the central canal. Through the dural defect and spina bifidait continued extradurally to the subcutaneous tissue. Nearly complete excision was possible in both patients.Skin manifestations of the malformation were different in the two patient. The first patient (female) hada tumour and skin haemangioma in the lumbosacral region. A dermal sinus pointed to th e existing anomaly in thesecond patient (male). The two patients differed as to the age of manifestation of neurological dysfunction andsurgical intervention, as well as to their postoperative functional reversibility. The first patient was operated atthe age of 10 months. Now, 19 months after surgery, she is asymptomatic, the functional changes proved to becompletely reversible. The second patient experienced the first functional problems at the age of 12 years and theyprogressed during the following years. He was operated when 14 years old. One year after the operation a slightreversal of functional changes was recorded, but no further improvement occurred later on. The age seems to haveplayed an important role in the reversal of deteriorated functions of patients with a tethered spinal cord causedby spinal lipoma.

Key words:
spinal lipoma, spina bifida, neural tube defect, tethered spinal cord