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Surgical Management of Complex Spinal Cord Lipomas : A New Perspective.
J Korean Neurosurg Soc. 2020 May; 63(3):279-313.JK

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.

Authors+Show Affiliations

Department of Paediatric Neurosurgery, Great Ormond Street Hospital for Children, NHS Trust, London, UK. Department of Paediatric Neurosurgery, University of California, Davis, CA, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32392666

Citation

Pang, Dachling. "Surgical Management of Complex Spinal Cord Lipomas : a New Perspective." Journal of Korean Neurosurgical Society, vol. 63, no. 3, 2020, pp. 279-313.
Pang D. Surgical Management of Complex Spinal Cord Lipomas : A New Perspective. J Korean Neurosurg Soc. 2020;63(3):279-313.
Pang, D. (2020). Surgical Management of Complex Spinal Cord Lipomas : A New Perspective. Journal of Korean Neurosurgical Society, 63(3), 279-313. https://doi.org/10.3340/jkns.2020.0024
Pang D. Surgical Management of Complex Spinal Cord Lipomas : a New Perspective. J Korean Neurosurg Soc. 2020;63(3):279-313. PubMed PMID: 32392666.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Surgical Management of Complex Spinal Cord Lipomas : A New Perspective. A1 - Pang,Dachling, Y1 - 2020/05/01/ PY - 2020/01/28/received PY - 2020/04/28/accepted PY - 2020/5/12/entrez PY - 2020/5/13/pubmed PY - 2020/5/13/medline KW - Progression-free survival KW - Spinal dysraphism SP - 279 EP - 313 JF - Journal of Korean Neurosurgical Society JO - J Korean Neurosurg Soc VL - 63 IS - 3 N2 - 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. SN - 2005-3711 UR - https://www.unboundmedicine.com/medline/citation/32392666/Surgical_Management_of_Complex_Spinal_Cord_Lipomas_:_A_New_Perspective_ L2 - http://jkns.or.kr/journal/view.php?doi=10.3340/jkns.2020.0024 DB - PRIME DP - Unbound Medicine ER -
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