Abstract
We present the surgical experiences of 99 (49 male, 50 female) patients ranging in age from 1 month to 52 years who were afflicted with lumbosacral lipomas. Preoperatively, 36 of the 99 were diagnosed as being neurologically intact while the remainder had verious neurological sequelae including reflex change, sensory disturbance, muscle weakness, and sphincter disorder. Preoperative neuroimaging permitted classifying lumbosacral lipomas into 5 categories : (1) dorsal, (2) caudal, (3) combined, (4) filar types, and (5) lipomyelomeningocele. Although all 99 patients untederwent unthering of the spinal cord, some lipomas remained untouched upon completion of surgery to avoid risks of injury to nervous tissues with respect to combined type lipomas and lipomyelomeningoceles. The lipoma could, on the other hand, be removed either subtotally or completely to untether the spinal cord in cases of caudal and filar type lipomas, and most dorsal type lipomas. In a mean postoperative follow-up period of 8.49 years, there was no significant deterioration among most patients, and some patients even demonstrated improved function. Four patients, however, developed bladder function deterioration postoperatively, 3 of them in a late-onset manner although unethering surgery successfully had been accomplished at between 3 and 4 months after birth. Our results indicated untethering surgery possibly could prevent neurological function deteriorating with advancing age in most patients with lumbosacral lipomas, but not for some patients even though the spinal cord was untethered during the early post-birth period.
