Conservative Management of Asymptomatic Spinal Lipomas of the Conus

Abhaya V. Kulkarni, Alain Pierre-Kahn, Michel Zerah, Paul H. Chapman, P. David Adelson, Alan R. Cohen, J. Gordon McComb

Research output: Contribution to journalArticle

Abstract

OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.

Original languageEnglish (US)
Pages (from-to)868-875
Number of pages8
JournalNeurosurgery
Volume54
Issue number4
DOIs
StatePublished - Apr 2004
Externally publishedYes

Keywords

  • Lipoma
  • Natural history
  • Pediatric
  • Spinal dysraphism
  • Surgery

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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    Kulkarni, A. V., Pierre-Kahn, A., Zerah, M., Chapman, P. H., Adelson, P. D., Cohen, A. R., & McComb, J. G. (2004). Conservative Management of Asymptomatic Spinal Lipomas of the Conus. Neurosurgery, 54(4), 868-875. https://doi.org/10.1227/01.NEU.0000114923.76542.81