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Role of surgery for maintaining urological function and prevention of retethering in the treatment of lipomeningomyelocele: experience recorded in 75 lipomeningomyelocele patients.
Childs Nerv Syst. 2003 Jan; 19(1):23-9.CN

Abstract

OBJECT

The authors tried to reveal some unique features of lipomeningomyelocele (LMMC), including clinical presentation, factors precipitating onset of symptoms, pathologic entities of LMMC associated with tethered cord syndrome, and surgical outcome in LMMC patients.

METHODS AND RESULTS

Seventy-five patients with LMMC were enrolled in this study. Neuro-imaging and intraoperative findings allowed classification of LMMC into three types: type I, type II, and type III. The patients were divided into two groups by age: A (51 patients), from birth to 3 years, and B (24 patients), from 3 to 24 years. For prevention of retethering of the cord, a mega-dural sac rebuilding procedure was performed in 15 patients. During a mean postoperative follow-up period of 4 years, the surgical outcome was satisfactory in terms of improved pain and motor weakness, but disappointing with reference to the resolution of bowel and bladder dysfunction. Among these 75 patients with LMMC, preoperative deficits were improved after surgery in 29 (39%), remained stable in 28 (37%), changed slightly in 13(17%), and worsened in 5 (7%). Patients in group A achieved better outcomes than those in group B. Depending on the type of lesion, patients with types I and II LMMC have better outcomes than those with type III LMMC: Finally, retethering of the cord with neurological deterioration occurred in 4 (5.3%) of the 75 patients, but no retethering was found in the 15 patients who were recently treated with a mega-dural sac rebuilding procedure.

CONCLUSION

Our data continue to support the opinion that early diagnosis and optimal surgery are still essential for the treatment of patients with LMMC, since there is a high likelihood of residual neurological functions that can be preserved. Based on our surgical experience of untethering and decompression of lipomas, a mega-dural sac repair is useful to prevent retethering of the cord.

Authors+Show Affiliations

Department of Neurosurgery, Kangnam St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 505 Banpo-dong Seocho-gu, Seoul 137-040, Korea. jkkmd@cmc.cuk.ac.krNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

12541082

Citation

Kang, Joon-Ki, et al. "Role of Surgery for Maintaining Urological Function and Prevention of Retethering in the Treatment of Lipomeningomyelocele: Experience Recorded in 75 Lipomeningomyelocele Patients." Child's Nervous System : ChNS : Official Journal of the International Society for Pediatric Neurosurgery, vol. 19, no. 1, 2003, pp. 23-9.
Kang JK, Lee KS, Jeun SS, et al. Role of surgery for maintaining urological function and prevention of retethering in the treatment of lipomeningomyelocele: experience recorded in 75 lipomeningomyelocele patients. Childs Nerv Syst. 2003;19(1):23-9.
Kang, J. K., Lee, K. S., Jeun, S. S., Lee, I. W., & Kim, M. C. (2003). Role of surgery for maintaining urological function and prevention of retethering in the treatment of lipomeningomyelocele: experience recorded in 75 lipomeningomyelocele patients. Child's Nervous System : ChNS : Official Journal of the International Society for Pediatric Neurosurgery, 19(1), 23-9.
Kang JK, et al. Role of Surgery for Maintaining Urological Function and Prevention of Retethering in the Treatment of Lipomeningomyelocele: Experience Recorded in 75 Lipomeningomyelocele Patients. Childs Nerv Syst. 2003;19(1):23-9. PubMed PMID: 12541082.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Role of surgery for maintaining urological function and prevention of retethering in the treatment of lipomeningomyelocele: experience recorded in 75 lipomeningomyelocele patients. AU - Kang,Joon-Ki, AU - Lee,Kwan-Sung, AU - Jeun,Sin-Soo, AU - Lee,Il-Woo, AU - Kim,Moon-Chan, Y1 - 2002/12/14/ PY - 2002/07/14/received PY - 2002/08/10/revised PY - 2003/1/24/pubmed PY - 2003/5/15/medline PY - 2003/1/24/entrez SP - 23 EP - 9 JF - Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery JO - Childs Nerv Syst VL - 19 IS - 1 N2 - OBJECT: The authors tried to reveal some unique features of lipomeningomyelocele (LMMC), including clinical presentation, factors precipitating onset of symptoms, pathologic entities of LMMC associated with tethered cord syndrome, and surgical outcome in LMMC patients. METHODS AND RESULTS: Seventy-five patients with LMMC were enrolled in this study. Neuro-imaging and intraoperative findings allowed classification of LMMC into three types: type I, type II, and type III. The patients were divided into two groups by age: A (51 patients), from birth to 3 years, and B (24 patients), from 3 to 24 years. For prevention of retethering of the cord, a mega-dural sac rebuilding procedure was performed in 15 patients. During a mean postoperative follow-up period of 4 years, the surgical outcome was satisfactory in terms of improved pain and motor weakness, but disappointing with reference to the resolution of bowel and bladder dysfunction. Among these 75 patients with LMMC, preoperative deficits were improved after surgery in 29 (39%), remained stable in 28 (37%), changed slightly in 13(17%), and worsened in 5 (7%). Patients in group A achieved better outcomes than those in group B. Depending on the type of lesion, patients with types I and II LMMC have better outcomes than those with type III LMMC: Finally, retethering of the cord with neurological deterioration occurred in 4 (5.3%) of the 75 patients, but no retethering was found in the 15 patients who were recently treated with a mega-dural sac rebuilding procedure. CONCLUSION: Our data continue to support the opinion that early diagnosis and optimal surgery are still essential for the treatment of patients with LMMC, since there is a high likelihood of residual neurological functions that can be preserved. Based on our surgical experience of untethering and decompression of lipomas, a mega-dural sac repair is useful to prevent retethering of the cord. SN - 0256-7040 UR - https://www.unboundmedicine.com/medline/citation/12541082/Role_of_surgery_for_maintaining_urological_function_and_prevention_of_retethering_in_the_treatment_of_lipomeningomyelocele:_experience_recorded_in_75_lipomeningomyelocele_patients_ L2 - https://doi.org/10.1007/s00381-002-0674-0 DB - PRIME DP - Unbound Medicine ER -