Spinal lipoma of the filum terminale: review of 174 consecutive patients
Spinal lipoma of the filum terminale: review of 174 consecutive patients
复制标题
DOI：
10.1007/s00381-016-3072-8
复制
发表时间：
2016-07-01
影响因子：
1.4
通讯作者：
Zerah, Michel
中科院分区：
文献类型：
--
作者：
Usami, Kenichi;Lallemant, Pauline;Zerah, Michel
脊髓终丝脂肪瘤是一种先天性腰骶部异常，可引起脊髓栓系综合征。本研究的目的是阐明LFT的术前特征，阐明手术效果，并讨论LFT预防性手术的基本原理。前瞻性记录了174例接受LFT切片的儿童（2008-2014年）的医疗数据，包括症状，皮肤污点和相关畸形的患病率，诊断的动机，圆锥水平和手术结果。手术时的平均年龄为4.1 ± 4.2岁（37天至17.7岁）。94名儿童（54.0%）有皮肤柱头，60名儿童（34.5%）有某些会阴畸形。79名儿童（45.4%）有症状。最常见的诊断动机是皮肤柱头（44.3%），其次是相关畸形（33.3%）和症状（20.1%）。有症状患者的手术年龄明显大于无症状患者（p < 0.001）。在2.1年的随访期内，50%的患者手术改善了症状。在85名无症状患者中，除1名患者外，所有患者术后均无症状，无症状患者恶化。相关畸形和圆锥水平的存在并不影响手术结果。术后并发症9例（5.2%）：7例一过性局部问题，1例明确的泌尿系统恶化，1例一过性呼吸系统问题。它改善了一半有症状的患者，并阻止了其他患者的恶化。即使只有一个无症状的患者在最大随访时恶化，预防性手术的作用仍然是一个讨论的焦点。
Spinal lipoma of the filum terminale (LFT) is a congenital lumbosacral anomaly that can cause tethered cord syndrome. Purposes of this study are to clarify preoperative characteristics of LFT, to elucidate surgical effects, and to discuss the rationale of prophylactic surgery for LFT.Medical data of 174 children (2008-2014) who underwent section of LFT were prospectively recorded for prevalence of symptoms, skin stigmas, and associated malformations, motivator of diagnosis, conus level, and surgical outcome. Mean age at surgery was 4.1 +/- 4.2 years (37 days to 17.7 years).Ninety-four children (54.0 %) had skin stigmas and 60 (34.5 %) had certain perineal malformations. Seventy-nine children (45.4 %) were symptomatic. The most common motivator for diagnosis was skin stigmas (44.3 %), followed by associated malformations (33.3 %), and symptoms (20.1 %). The age at surgery was significantly older in symptomatic patients than in asymptomatic patients (p < 0.001). Surgery improved symptoms in 50 % of patients at 2.1-year follow-up period. Of 85 asymptomatic patients, all except one remained asymptomatic postoperatively and none of the symptomatic patients deteriorated. The presence of associated malformations and the conus level did not affect surgical outcome. Postoperative complications developed in nine patients (5.2 %): seven transient local problems, one definitive urological deterioration, and one transient respiratory problem.Surgery for LFT was a simple and safe procedure. It improved half of symptomatic patients and stopped the deterioration of the others. Even if only one of the asymptomatic patients deteriorated at maximum follow-up, the role of prophylactic surgery remains a point of discussion.