Kulkarni Abhaya V, Pierre-Kahn Alain, Zerah Michel
Service de Neurochirurgie Pédiatrique, Groupe Hospitalier Necker-Enfants Malades, 149 rue de Sevres, 75743 Paris Cedex 15, France.
Neurosurgery. 2004 Apr;54(4):868-73; discussion 873-5. doi: 10.1227/01.neu.0000114923.76542.81.
The natural history of spinal lipomas of the conus (SLCs) has not been well studied. Because of disappointing long-term results with early surgical treatment of asymptomatic children with SLCs, we have followed a protocol of conservative management for these patients. The results are presented in this report.
Since 1994, all asymptomatic children with SLCs who were examined at Necker-Enfants Malades Hospital were subject to a protocol of conservative management. The records for those patients were reviewed, to determine the incidence and timing of neurological deterioration. The findings were compared with those for a previously reported historical cohort of asymptomatic patients who underwent early surgery at our institution.
Fifty-three asymptomatic children (35 girls and 18 boys) with SLCs were monitored, with conservative management. During a mean follow-up period of 4.4 years (range, 12 mo to 9 yr), 13 patients (25%) exhibited neurological deterioration. At 9 years, the actuarial risks of deterioration, as determined with the Kaplan-Meier method, were 33% for the conservatively treated patients and 46% for the surgically treated patients. With a Cox proportional-hazards model, there was no significant difference in the risks of neurological deterioration for patients who were treated conservatively and those who underwent early surgery.
The incidences and patterns of neurological deterioration seemed to be very similar, regardless of whether early surgery was performed. These results suggest that conservative treatment of asymptomatic patients is a reasonable option. A more definitive randomized study will be required to clarify the relative efficacy of early surgery for SLCs among asymptomatic patients.
圆锥脊髓脂肪瘤（SLCs）的自然病史尚未得到充分研究。由于对无症状SLCs患儿进行早期手术治疗的长期效果令人失望，我们对这些患者采用了保守治疗方案。本报告展示了相关结果。
自1994年以来，所有在尼克尔儿童医院接受检查的无症状SLCs患儿均采用保守治疗方案。对这些患者的记录进行回顾，以确定神经功能恶化的发生率和时间。将这些结果与我们机构之前报道的一组接受早期手术的无症状患者的历史队列结果进行比较。
对53例无症状SLCs患儿（35例女孩和18例男孩）进行了保守治疗监测。在平均4.4年的随访期内（范围为12个月至9年），13例患者（25%）出现神经功能恶化。采用Kaplan-Meier方法确定，在9年时，保守治疗患者的恶化精算风险为33%，手术治疗患者为46%。使用Cox比例风险模型，保守治疗患者和早期手术患者的神经功能恶化风险无显著差异。
无论是否进行早期手术，神经功能恶化的发生率和模式似乎非常相似。这些结果表明，对无症状患者进行保守治疗是一种合理的选择。需要进行更明确的随机研究，以阐明早期手术对无症状患者SLCs的相对疗效。
