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Asymptomatic lipomas of the medullary conus: surgical treatment versus conservative management.
J Neurosurg Pediatr. 2014 Sep; 14(3):245-54.JN

Abstract

OBJECT

The goal of this study was to compare long-term results of surgery with the outcomes of conservative treatment in patients with asymptomatic lipomas of the conus medullaris.

METHODS

The parents of 56 consecutive children with a diagnosis of asymptomatic lipoma of the conus medullaris underwent detailed neurosurgical consultation. The pros and cons of both prophylactic surgery and conservative treatment were carefully presented. Both options were offered, and the parents were free to choose the preferred management. A total of 32 children underwent surgical treatment, and 24 were conservatively treated. Afterward, all patients entered the same protocol of serial neurological and urological follow-up at the Centro Spina Bifida. The mean follow-up periods were 9.7 years in the surgical treatment group and 10.4 years in the conservative treatment group.

RESULTS

Permanent surgical morbidity was 3.1% (1 patient). During follow-up, tethered cord syndrome occurred in 9.7% of the surgically treated patients (3 of 32 patients) and in 29.1% of the conservatively managed children (7 of 24 patients). This difference did not result in statistical significance, but a clear trend in favor of surgery emerged. Young age at surgery and a cord/sac ratio < 50% appeared to be determining factors in the prevention of subsequent tethered cord syndrome.

CONCLUSIONS

The small size of this series does not provide enough statistical evidence that surgical treatment can really improve the natural history of asymptomatic lipomas of the conus medullaris. Nevertheless, surgery appears at least advisable since it reduces by 75% the odds of TCS (p = 0.067), which is quite close to statistical significance.

Authors+Show Affiliations

Department of Neurosurgery.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

24971607

Citation

Talamonti, Giuseppe, et al. "Asymptomatic Lipomas of the Medullary Conus: Surgical Treatment Versus Conservative Management." Journal of Neurosurgery. Pediatrics, vol. 14, no. 3, 2014, pp. 245-54.
Talamonti G, D'Aliberti G, Nichelatti M, et al. Asymptomatic lipomas of the medullary conus: surgical treatment versus conservative management. J Neurosurg Pediatr. 2014;14(3):245-54.
Talamonti, G., D'Aliberti, G., Nichelatti, M., Debernardi, A., Picano, M., & Redaelli, T. (2014). Asymptomatic lipomas of the medullary conus: surgical treatment versus conservative management. Journal of Neurosurgery. Pediatrics, 14(3), 245-54. https://doi.org/10.3171/2014.5.PEDS13399
Talamonti G, et al. Asymptomatic Lipomas of the Medullary Conus: Surgical Treatment Versus Conservative Management. J Neurosurg Pediatr. 2014;14(3):245-54. PubMed PMID: 24971607.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Asymptomatic lipomas of the medullary conus: surgical treatment versus conservative management. AU - Talamonti,Giuseppe, AU - D'Aliberti,Giuseppe, AU - Nichelatti,Michele, AU - Debernardi,Alberto, AU - Picano,Marco, AU - Redaelli,Tiziana, Y1 - 2014/06/27/ PY - 2014/6/28/entrez PY - 2014/6/28/pubmed PY - 2014/10/21/medline KW - LCM = lipoma of the conus medullaris KW - TCS = tethered cord syndrome KW - conus medullaris KW - lipoma KW - natural history KW - pediatric neurosurgery KW - spinal dysraphism KW - spine KW - tethered cord syndrome SP - 245 EP - 54 JF - Journal of neurosurgery. Pediatrics JO - J Neurosurg Pediatr VL - 14 IS - 3 N2 - OBJECT: The goal of this study was to compare long-term results of surgery with the outcomes of conservative treatment in patients with asymptomatic lipomas of the conus medullaris. METHODS: The parents of 56 consecutive children with a diagnosis of asymptomatic lipoma of the conus medullaris underwent detailed neurosurgical consultation. The pros and cons of both prophylactic surgery and conservative treatment were carefully presented. Both options were offered, and the parents were free to choose the preferred management. A total of 32 children underwent surgical treatment, and 24 were conservatively treated. Afterward, all patients entered the same protocol of serial neurological and urological follow-up at the Centro Spina Bifida. The mean follow-up periods were 9.7 years in the surgical treatment group and 10.4 years in the conservative treatment group. RESULTS: Permanent surgical morbidity was 3.1% (1 patient). During follow-up, tethered cord syndrome occurred in 9.7% of the surgically treated patients (3 of 32 patients) and in 29.1% of the conservatively managed children (7 of 24 patients). This difference did not result in statistical significance, but a clear trend in favor of surgery emerged. Young age at surgery and a cord/sac ratio < 50% appeared to be determining factors in the prevention of subsequent tethered cord syndrome. CONCLUSIONS: The small size of this series does not provide enough statistical evidence that surgical treatment can really improve the natural history of asymptomatic lipomas of the conus medullaris. Nevertheless, surgery appears at least advisable since it reduces by 75% the odds of TCS (p = 0.067), which is quite close to statistical significance. SN - 1933-0715 UR - https://www.unboundmedicine.com/medline/citation/24971607/Asymptomatic_lipomas_of_the_medullary_conus:_surgical_treatment_versus_conservative_management_ L2 - https://thejns.org/doi/10.3171/2014.5.PEDS13399 DB - PRIME DP - Unbound Medicine ER -