Asymptomatic lumbosacral lipomas-a natural history study
Asymptomatic lumbosacral lipomas-a natural history study
复制标题
DOI：
10.1007/s00381-012-1775-z
复制
发表时间：
2012-10-01
影响因子：
1.4
通讯作者：
Thompson, Dominic N. P.
中科院分区：
文献类型：
--
作者：
Wykes, Victoria;Desai, Divyesh;Thompson, Dominic N. P.
由于机械拴系导致的不可避免的恶化被认为是脊髓圆锥区域复杂的先天性脊柱脂肪瘤的自然病史，即使在表现时没有症状。预防性手术松解改善预后的传统观点最近受到了挑战[1，2]。这项研究考察了无症状的未手术的腰椎脂肪瘤(LSL)儿童的自然病史，并调查了预测因素是否预示着病情的恶化。在过去的十年里，英国伦敦大奥蒙德街医院(GOSH)的一名临床医生对患有复杂LSL的儿童进行了全面的评估，重点是神经和泌尿学评估以及腰椎MRI。对于被认为没有症状的儿童，已采取保守治疗，并定期密切监测神经和泌尿功能，从而避免松绑手术，除非出现症状恶化。一项回顾发现了这群没有LSL症状的儿童，并密切记录了他们的进展。这项研究表明，这一亚组呼吸障碍患者的自然病史可能比迄今认为的更良性。保守治疗，采用新的监测策略，仅在症状恶化时及时干预，导致71%的患者在平均5.9年(范围1.0-19.3年)的随访期内保持临床无症状。10年后，用Kaplan-Meier方法确定的累积恶化风险为40%。2岁的儿童，女性，存在过渡型LSL和相关的空洞，独立地与更高的恶化风险相关。
Inevitable deterioration due to mechanical tethering is perceived as the natural history for complex congenital spinal lipomas of the conus medullaris region, even if asymptomatic at presentation. The conventional wisdom that prophylactic surgical untethering improves outcome has been challenged recently [1, 2]. This study examines the natural history of asymptomatic un-operated children with lumbosacral lipomas (LSL) and investigates whether predictive factors herald deterioration.Over the past decade, children presenting with complex LSL to a single clinician at Great Ormond Street Hospital (GOSH), London, UK have undergone a thorough assessment focusing on neurological and urological evaluation and MRI of the lumbosacral spine. For children deemed to be asymptomatic, conservative management has been adopted with close periodic surveillance of neurological and urological function, thus avoiding untethering surgery unless symptomatic deterioration occurs. A retrospective review identified this cohort of children asymptomatic of their LSL and their progress closely recorded.This study suggests that the natural history of this subgroup of dysraphic patients may be more benign than hitherto considered. Conservative management with adoption of a novel surveillance policy and timely intervention only in the presence of symptomatic deterioration resulted in 71 % of this series remaining clinically asymptomatic at mean follow up period of 5.9 years (range, 1.0-19.3 years). At 10 years, the cumulative risk of deterioration determined by the Kaplan-Meier method was 40 %. Children aged < 2 years, female, with presence of a transitional type of LSL and associated syrinx were independently associated with a higher risk of deterioration.