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59. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
3. Joint Meeting mit der Italienischen Gesellschaft für Neurochirurgie (SINch)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

01. - 04.06.2008, Würzburg

Problems and pitfalls in spinal lipoma surgery

Probleme und Problemvermeidung in der Chirurgie spinaler Lipome

Meeting Abstract

  • corresponding author J. Krauß - Abteilung für Pädiatrische Neurochirurgie der Neurochirurgischen Universitätsklinik, Würzburg
  • C. Schropp - Pädiatrische Universitätsklinik, Würzburg
  • T. Schweitzer - Abteilung für Pädiatrische Neurochirurgie der Neurochirurgischen Universitätsklinik, Würzburg
  • H. Collmann - Abteilung für Pädiatrische Neurochirurgie der Neurochirurgischen Universitätsklinik, Würzburg
  • N. Sörensen - Abteilung für Pädiatrische Neurochirurgie der Neurochirurgischen Universitätsklinik, Würzburg

Deutsche Gesellschaft für Neurochirurgie. Società Italiana di Neurochirurgia. 59. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3. Joint Meeting mit der Italienischen Gesellschaft für Neurochirurgie (SINch). Würzburg, 01.-04.06.2008. Düsseldorf: German Medical Science GMS Publishing House; 2008. DocMO.06.11

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2008/08dgnc085.shtml

Veröffentlicht: 30. Mai 2008

© 2008 Krauß et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective: Surgery for spinal lipomas of dysraphic origin is fraught with difficulties and problems due to often complex malformations. Completeness of surgical reconstruction has to be balanced with the risk of neurological injury. Limitations in the long-term efficiency of lipoma untethering have to be considered and have led to serious doubts about the value of prophylactic surgery.

Methods: Systematic overview on problems encountered and strategies for complication avoidance in surgery on spinal lipomas, drawing on experience with 320 patients under 18 years of age operated on for spinal lipomas excluding filum lipomas from 1979 to 2006.

Results: Surgical planning will be oriented on classification of the lipoma as dorsal, caudal or transitional type as well as presence of a true lipomyelomeningocele with epifascial extension of CSF and spinal cord. The malformation should be exposed with reconstruction of dural sac and fascial closure in mind, especially at the caudal end. Osteoplastic laminotomy of intact laminae reduces the risk of late onset lumbar pain and discomfort. CO2-laser resection is helpful for lipoma resection, meticulous prevention of blood spilling into the subarachnoid space is essential to limit postoperative arachnopathy. Intraoperative monitoring is useful for mapping of the segmental innervation and identification of nerve roots, the overall impact on surgical results is limited however. Prevention of CSF leakage must be based on watertight fascial closure as dural closure alone will not provide an effective barrier. Subcutaneous lipoma resection for cosmetic reasons should be performed as a last step before wound closure and only be done once a watertight fascial closure has been obtained. The difficulty of the procedure and the prognosis of the patient will be determined not by the type of lipoma attachment but by the amount of lateral involvement of the spinal cord, volume of the malformed spinal cord complex and degree of nerve root dysplasia. These factors, especially functioning nerve roots encased in the malformation, limit the extent of untethering and lipoma resection. 18% of cases were incompletely untethered in our series, these patients had a 3-fold risk of secondary deterioriation with reoperation. Overall, 60 patients required reoperation.

Conclusions: The limitations for the surgical correction of spinal lipomas and the high incidence of secondary deterioriation despite adequate surgery demand a maximum effort of complication avoidance to keep these interventions justified.