Spinal Lipomas in Children
Spinal Lipomas in Children
复制标题
儿童脊柱脂肪瘤
作者：
C. Xenos;S. Sgouros;Richard A. Walsh;A. Hockley
脊髓脂肪瘤是脊髓栓系的常见原因，可导致进行性神经功能缺损。脊髓脂肪瘤的预防性手术的作用最近受到质疑。在1985年至1999年期间，59名儿童在英国伯明翰的伯明翰儿童医院接受了总共69次外科手术。脊髓脂肪瘤分为：18个终端，17个过渡性，6个背和18个细丝脂肪瘤-包括12个谁有一个典型的终丝增厚。首次手术时，19例患者（32%）无症状，40例患者（68%）出现症状。无症状组的手术指征包括存在真皮窦道或瘘管。在选定的病例中进行了预防性手术。该组自首次手术以来的平均总随访时间为61.8个月（范围：7.0-203.0个月）。在无症状组中，26%的患者有晚期神经功能恶化。在14例无症状圆锥脂肪瘤患者中，3例（21%）在长期随访时出现括约肌功能障碍和运动问题。在有症状组中，68%改善，20%保持不变，12%有晚期神经功能恶化。18例有症状的丝状脂肪瘤患者术后无一例恶化。然而，39%有膀胱功能障碍，54%有神经矫形畸形，只有15%在最近的随访中恢复了整体正常功能。在27例有症状的圆锥脂肪瘤患者中，67%改善，15%保持稳定，18%有晚期神经功能恶化。然而，在长期随访中，74%有膀胱功能障碍，67%有神经矫形畸形，45%有运动问题。脊柱脂肪瘤可引起进行性神经功能缺损，无论脊柱松解手术。这项研究表明，细丝和圆锥脂肪瘤有相似的临床表现，但在手术后的结果不同。丝状脂肪瘤是良性的，手术治疗是安全有效的。芋螺脂肪瘤更难处理。当无症状时，我们的研究结果表明，预防性手术确实提供了一些保护，防止未来的神经系统恶化。当出现症状时，圆锥脂肪瘤手术可以有效阻止进一步恶化。神经功能可以改善，但很少有患者恢复正常的整体功能，并且手术不会显著改变预先存在的括约肌功能障碍。
Spinal cord lipomas are a common cause of cord tethering that can lead to progressive neurological defects. The role of prophylactic surgery for spinal lipomas has recently been questioned. Between 1985 and 1999, 59 children underwent a total of 69 surgical procedures at the Birmingham Children’s Hospital in Birmingham, UK. The spinal lipomas were classified into: 18 terminal, 17 transitional, 6 dorsal and 18 filum lipomas – including 12 who had a typical thickened filum terminale. At the first operation, 19 patients (32%) were asymptomatic, and 40 patients (68%) presented with symptoms. Surgical indications in the asymptomatic group included the presence of a dermal sinus tract or syrinx. Prophylactic surgery was undertaken in selected cases. The mean total follow-up for the group since the first surgical procedure was 61.8 months (range: 7.0–203.0 months). In the asymptomatic group, 26% of the patients had late neurological deterioration. Of the 14 patients with asymptomatic conus lipomas, 3 (21%) developed sphincter dysfunction and motor problems at long-term follow-up. In the symptomatic group, 68% improved, 20% remained unchanged, and 12% had late neurological deterioration. None of the 18 patients with symptomatic filum lipoma deteriorated postoperatively. However, 39% had bladder dysfunction, 54% had neuro-orthopaedic deformity, and only 15% returned to overall normal function at latest follow-up. Of the 27 patients with symptomatic conus lipomas, 67% improved, 15% remained stable, and 18% had late neurological deterioration. However, 74% had bladder dysfunction, 67% had neuro-orthopaedic deformity, and 45% had motor problems at long-term follow-up. Spinal lipomas can cause progressive neurological deficits irrespective of spinal untethering surgery. This study demonstrates that filum and conus lipomas have similar clinical presentation, but differ in their outcome following surgery. Filum lipomas are ‘benign’, for which surgery is safe and effective. Conus lipomas are more difficult to manage. When asymptomatic, our results suggest that prophylactic surgery does provide some protection from future neurological deterioration. When symptomatic, conus lipoma surgery is effective in stopping further deterioration. Improvement in neurological function can occur, but few patients return to normal overall function, and pre-existing sphincter dysfunction is not significantly altered by surgery.
儿童脂肪脊髓脊膜膨出的治疗和长期随访回顾，1952-1987 年。
影响因子：
4.1
作者：
Kanev,PM;Lemire,RJ;Loeser,JD;Berger,MS
通讯作者：
Berger,MS