Conservative management of asymptomatic spinal lipomas of the conus
Conservative management of asymptomatic spinal lipomas of the conus
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DOI：
10.1227/01.neu.0000114923.76542.81
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发表时间：
2004-04-01
期刊：
影响因子：
4.8
通讯作者：
Zerah, M
中科院分区：
文献类型：
--
作者：
Kulkarni, AV;Pierre-Kahn, A;Zerah, M
目的：脊髓圆锥脂肪瘤（SLCs）的自然历史尚未得到很好的研究。由于早期手术治疗无症状儿童SLCs的长期效果令人失望，我们对这些患者采用了保守治疗方案。方法：自1994年以来，在Necker-Enfants Malades医院接受检查的所有无症状SLCs儿童均采用保守治疗方案。对这些患者的记录进行了回顾，以确定神经系统恶化的发生率和时间。研究结果与先前报道的在我院接受早期手术的无症状患者的历史队列进行了比较。结果：53例无症状的SLCs患儿（315例女孩，18例男孩）接受了保守治疗。在平均4.4年的随访期间（12个月至9年），13名患者（25%）表现出神经功能恶化。用Kaplan-Meier法确定的9年精算恶化风险，保守治疗患者为33%，手术治疗患者为46%。Cox比例风险模型显示，保守治疗和早期手术患者的神经功能恶化风险无显著差异。结论：无论是否早期手术，神经功能恶化的发生率和模式似乎非常相似。这些结果提示对无症状患者进行保守治疗是一种合理的选择。需要一项更明确的随机研究来阐明无症状SLCs患者早期手术的相对疗效。
OBJECTIVE: The natural history of spinal lipomas of the conus (SLCs) has not been well studied. Because of disappointing long-term results with early surgical treatment of asymptomatic children with SLCs, we have followed a protocol of conservative management for these patients The results are presented in this report.METHODS: Since 1994, all asymptomatic children with SLCs who were examined at Necker-Enfants Malades Hospital were subject to a protocol of conservative management. The records for those patients were reviewed, to determine the incidence and timing of neurological deterioration. The findings were compared with those for a previously reported historical cohort of asymptomatic patients who underwent early surgery at our institution.RESULTS: Fifty-three asymptomatic children (315 girls and 18 boys) with SLCs were monitored, with conservative management. During a mean follow-up period of 4.4 years (range, 12 mo to 9 yr), 13 patients (25%) exhibited neurological deterioration. At 9 years the actuarial risks of deterioration, as determined with the Kaplan-Meier method, were 33% for the conservatively treated patients and 46% for the surgically treated patients. With a Cox proportional-hazards model, there was no significant difference in the risks of neurological deterioration for patients who were treated conservatively and those who underwent early surgery.CONCLUSION: The incidences and patterns of neurological deterioration seemed to be very similar, regardless of whether early surgery was performed. These results suggest that conservative treatment of asymptomatic patients is a reasonable option. A more definitive randomized study will be required to clarify the relative efficacy of early surgery for SLCs among asymptomatic patients.