Chong Sangjoon, Lee Ji Yeoun, Kim Kyung Hyun, Shin Hyung-Ik, Kim Keewon, Park Kwanjin, Kim Seung-Ki, Wang Kyu-Chang
Department of Neurosurgery, Asan Medical Center, Seoul, Republic of Korea.
Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
Childs Nerv Syst. 2019 Sep;35(9):1591-1597. doi: 10.1007/s00381-019-04212-1. Epub 2019 May 31.
Indication, timing, and method for surgical treatment of lumbosacral lipoma are controversial. Radical resection of the lumbosacral lipoma and complete reconstruction of the placode are supported in that better long-term outcome can be achieved without increasing complication rate compared with traditional surgical techniques.
We analyzed the early surgical outcomes of lumbosacral lipoma treated with the untethering and radical excision of fat.
Retrospective analysis of surgically treated 81 fresh lumbosacral lipoma cases with dorsal, transitional, and chaotic types and true lipomyelomeningocele (LMMC) was performed. Caudal and filar types were excluded.
Complete untethering was accomplished in 98%. Radical excision of the lipoma was attempted in all cases and achieved in 83%. Postoperative neurological complication was observed in 8 cases (10%). Group of lipoma types (dorsal + transitional vs. chaotic + true LMMC) and availability of radical lipoma excision turn out to be factors related to neurological outcomes in univariate analysis (p < 0.001 and p = 0.027, respectively). Group of lipoma types, availability of radical excision, and postoperative cord/dural sac (C/D) ratio are related factors in multivariate analysis (p = 0.025, p = 0.049, and p = 0.031).
As a follower of untethering and radical excision of fat, careful consideration is required to plan the surgery of lumbosacral lipoma on account of the "underestimated" complication rate. Type of the lipoma is the important factor determining the surgical outcome. Availability of complete radical excision and postoperative C/D ratio are the operative factors related to the neurological outcomes.
腰骶部脂肪瘤的手术治疗指征、时机和方法存在争议。支持对腰骶部脂肪瘤进行根治性切除并对基板进行完全重建，因为与传统手术技术相比，这样可以在不增加并发症发生率的情况下获得更好的长期疗效。
我们分析了采用脂肪松解和根治性切除治疗腰骶部脂肪瘤的早期手术结果。
对81例经手术治疗的新鲜腰骶部脂肪瘤病例进行回顾性分析，这些病例包括背侧型、过渡型和混合型以及真性脂肪脊髓脊膜膨出（LMMC）。排除尾侧型和丝状型。
98%的病例实现了完全松解。所有病例均尝试进行脂肪瘤的根治性切除，其中83%成功。术后观察到8例（10%）出现神经并发症。单因素分析显示，脂肪瘤类型组（背侧+过渡型与混合型+真性LMMC）和根治性脂肪瘤切除的可行性是与神经学结果相关的因素（分别为p < 0.001和p = 0.027）。多因素分析显示，脂肪瘤类型组、根治性切除的可行性以及术后脊髓/硬脊膜囊（C/D）比值是相关因素（p = 0.025、p = 0.049和p = 0.031）。
作为脂肪松解和根治性切除的追随者，由于并发症发生率“被低估”，在计划腰骶部脂肪瘤手术时需要仔细考虑。脂肪瘤类型是决定手术结果的重要因素。完全根治性切除的可行性和术后C/D比值是与神经学结果相关的手术因素。
