Byrne R W, Hayes E A, George T M, McLone D G
Department of Neurosurgery, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Ill., USA.
Pediatr Neurosurg. 1995;23(4):182-6; discussion 186-7. doi: 10.1159/000120956.
A retrospective analysis of 100 children followed at Children's Memorial Hospital, Chicago, who underwent surgery for a spinal lipoma was performed. The mean follow-up was 5 years. We found that an operation performed during the 1st year of life with the goal of untethering the spinal cord and debulking the spinal lipoma was safe and effective, whereas a cosmetic (nonuntethering) procedure always led to delayed postoperative deterioration (symptomatic tethered cord). Of the infants that presented with motor, urologic or orthopedic symptoms, 39% improved, 58% stabilized, while 3% worsened as a result of surgery. No asymptomatic infant deteriorated postoperatively and 93% of these children remained symptom-free at follow-up (mean follow-up was 44 months). The overall outcome of infants after untethering procedures in this study was significantly better than the natural history of spinal lipomas. Several risk factors were identified that may predispose children to delayed postoperative deterioration: an initial cosmetic procedure; the presence of preoperative symptoms, and the presence of a lipomyelomeningocele.
对在芝加哥儿童纪念医院接受脊柱脂肪瘤手术的100名儿童进行了回顾性分析。平均随访时间为5年。我们发现，在生命的第1年进行的旨在松解脊髓和减少脊柱脂肪瘤体积的手术是安全有效的，而美容（非松解）手术总是导致术后延迟恶化（症状性脊髓拴系）。出现运动、泌尿或骨科症状的婴儿中，39%有所改善，58%病情稳定，而3%因手术而恶化。无症状婴儿术后无恶化情况，这些儿童中有93%在随访时仍无症状（平均随访44个月）。本研究中婴儿在松解手术后的总体结果明显优于脊柱脂肪瘤的自然病程。确定了几个可能使儿童易发生术后延迟恶化的危险因素：最初的美容手术；术前症状的存在，以及脂肪脊髓脊膜膨出的存在。
