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Surgical management of complex spinal cord lipomas: how, why, and when to operate. A review.
J Neurosurg Pediatr. 2019 05 01; 23(5):537-556.JN

Abstract

This review summarizes the classification, anatomy, and embryogenesis of complex spinal cord lipomas, and it 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 fares better than conservative treatment-i.e., no surgery-for asymptomatic lipomas. Accordingly, the 24-year progression-free survival data of the author and colleagues' series of over 300 cases of total resection are compared with historical data from multiple series (including the author and colleagues' own) of partial resection, and total resection data specifically for asymptomatic lesions are compared with the two known series of nonsurgical treatment of equivalent numbers of 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 this aggressive surgical approach and consequently projects worse results (admittedly of a 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.

Authors

No affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

31042665

Citation

Pang, Dachling. "Surgical Management of Complex Spinal Cord Lipomas: How, Why, and when to Operate. a Review." Journal of Neurosurgery. Pediatrics, vol. 23, no. 5, 2019, pp. 537-556.
Pang D. Surgical management of complex spinal cord lipomas: how, why, and when to operate. A review. J Neurosurg Pediatr. 2019;23(5):537-556.
Pang, D. (2019). Surgical management of complex spinal cord lipomas: how, why, and when to operate. A review. Journal of Neurosurgery. Pediatrics, 23(5), 537-556. https://doi.org/10.3171/2019.2.PEDS18390
Pang D. Surgical Management of Complex Spinal Cord Lipomas: How, Why, and when to Operate. a Review. J Neurosurg Pediatr. 2019 05 1;23(5):537-556. PubMed PMID: 31042665.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Surgical management of complex spinal cord lipomas: how, why, and when to operate. A review. A1 - Pang,Dachling, PY - 2019/01/26/received PY - 2019/02/04/accepted PY - 2019/5/3/entrez PY - 2019/5/3/pubmed PY - 2019/10/8/medline KW - BCR = bulbocavernosus reflex KW - DREZ = dorsal root entry zone KW - EMG = electromyography KW - MCA = multiple correspondence analysis KW - ONTD = open neural tube defect KW - PFS = progression-free survival KW - TcMEP = transcortical motor evoked potential KW - chaotic lipoma KW - complex spinal cord lipomas KW - intraoperative electrophysiological monitoring KW - long-term outcome KW - preoperative patient profiling KW - progression-free survival KW - spinal dysraphism KW - spine KW - surgical technique KW - total resection SP - 537 EP - 556 JF - Journal of neurosurgery. Pediatrics JO - J Neurosurg Pediatr VL - 23 IS - 5 N2 - This review summarizes the classification, anatomy, and embryogenesis of complex spinal cord lipomas, and it 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 fares better than conservative treatment-i.e., no surgery-for asymptomatic lipomas. Accordingly, the 24-year progression-free survival data of the author and colleagues' series of over 300 cases of total resection are compared with historical data from multiple series (including the author and colleagues' own) of partial resection, and total resection data specifically for asymptomatic lesions are compared with the two known series of nonsurgical treatment of equivalent numbers of 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 this aggressive surgical approach and consequently projects worse results (admittedly of a 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. SN - 1933-0715 UR - https://www.unboundmedicine.com/medline/citation/31042665/Surgical_management_of_complex_spinal_cord_lipomas:_how_why_and_when_to_operate__A_review_ L2 - https://thejns.org/doi/10.3171/2019.2.PEDS18390 DB - PRIME DP - Unbound Medicine ER -