Surgery for spinal cord lipomas
Surgery for spinal cord lipomas
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DOI：
10.1007/s12098-007-0060-8
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发表时间：
2007-04-01
影响因子：
4.3
通讯作者：
Mahapatra, Ashok K.
中科院分区：
文献类型：
--
作者：
Kasliwal, Manish K.;Mahapatra, Ashok K.
目标。分析脊髓脂肪瘤手术后的结果。方法。作者报告了他们对 2001 年至 2005 年期间在印度新德里全印度医学科学研究所（一家三级护理神经外科中心）接受治疗的 63 名非连续随机脊髓脂肪瘤儿童的治疗结果。结果。 63例中，圆锥脂肪瘤32例（52%），丝状脂肪瘤14例（22%），脂肪脑膜脊髓膨出（lipoMMC）14例（22%），脂肪脊髓囊肿2例（2.5%），混合性脂肪瘤1例（1.5%）。直到最后一次随访，无论脂肪瘤的类型如何，术前无症状的患者均未出现神经功能恶化。在那些已有神经功能缺损的患者中，运动、感觉和膀胱异常的改善程度分别仅为 15%、16% 和 21%。先前患有神经功能缺损的儿童均未恢复整体正常功能。尽管如此，手术后症状的改善使患者过上了更好的社交生活。只有 6% 的患者在手术后出现神经功能恶化，所有这些都发生在术前已经存在缺陷的患者中。结论。作者建议无论脂肪瘤的类型如何，预防性手术对于预防神经功能缺损都是安全有效的。大多数患者一旦出现神经功能障碍，即使在手术后也只能在一定程度上受益。建议进行密切的长期随访，以便即使在接受预防性手术的儿童中也能发现神经功能恶化。
Objectives. To analyze the results after surgery for spinal cord lipomas.Methods. The authors report their results of management of 63 non consecutive random children with spinal cord lipomas treated over a period from 2001 to 2005, at the All India Institute of Medical Sciences, New Delhi, India, a tertiary care neurosurgical centre.Results. There were 63 cases consisting of 32 (52%) conus lipomas, 14 (22%) filum lipomas, 14 (22%) lipomeningomyelocele (lipoMMC), 2 (2.5%) cases of lipomyelocystocele and one (1.5%) case of mixed lipoma. None of the patients who were asymptomatic before surgery deteriorated neurologically, irrespective of the type of lipoma till the last follow up. In those patients with preexisting neurological deficits, the improvement in motor, sensory and bladder abnormalities was only to an extent of 15 %, 16 % and 21 % respectively. None of the children with preexisting neurological deficit regained overall normal function. Nevertheless, the improvement in symptoms after surgery made the patients lead a better social life. Only 6 % of patients developed deterioration in neurological function after surgery, all of them occurring in patients already having pre-operative deficits.Conclusions. The authors recommend prophylactic surgery which is safe and effective in preventing neurological deficits, irrespective of the type of lipoma. Most of the patients benefit only to some extent even after surgery, once they develop neurological dysfunction. A close long term follow up is recommended in order to detect neurological deterioration even in children operated prophylactically.