Lipomyelomeningocele: pathology, treatment, and outcomes

Abstract

<jats:p>Lipomyelomeningocele represents a rare but complex neurological disorder that may present with neurological deterioration secondary to an inherent tethered spinal cord. Radiological testing is beneficial in determining the morphology of the malformation. Specialized testing such as urodynamic studies and neurophysiological testing may be beneficial in assessing for neurological dysfunction secondary to the lipomyelomeningocele. Early surgical intervention may be beneficial in preventing further neurological decline.</jats:p>

Minimally invasive endoscopic spinal cord untethering: case report

“…The diagnosis can easily be missed because tethered cord syndrome is much rarer than the presentation of degenerative disc disease or lumbar radiculopathy for which it can be easily mistaken, as in the case presented. The standard open surgery for cord untethering consists of a multilevel laminectomy, dural opening, identification of the filum and sectioning it (when untethering only requires filum sectioning) (1,2). Other studies have shown that minimally invasive open microscopic approaches with tubular and expandable retractors are sufficient to achieve the same goals as traditional open approaches (6,7).…”

“…Lipomyelomeningocele is a closed neural tube defect in which a subcutaneous lipoma extends through a defect in the fascia and attaches to an elongated and tethered spinal cord (1,2). Loss of neurologic function can occur over time and is believed to be secondary to increased stretch on the spinal cord due to patient growth.…”

Identical twins with lumbosacral lipomyelomeningocele

“…Because it is a big concern for the families, the recurrence rate of NTD has been studied specifically for MMC, but the literature lacks significant information about LMMC recurrence in families. [14][15][16] Recurrent risk of NTD has been reported in families with NTD subtypes. In an American study, the siblings of patients with LMMC have been affected by MMC, anencephaly, or fatty filum, but no recurrence of LMMC has been observed in this population.…”

“…2 The location of this adipose tissue is often used as a criterion for classification of LMMC, including dorsal, caudal, and transitional types. 14 Regarding the cause of LMMC, as well as other types of NTDs, it is supported that both environmental and genetic factors play a part in the occurrence of this defect. The environmental risk factors for LMMC might be similar to those for other NTDs including ethnicity, maternal age, 14 obesity, 3,14 diabetes mellitus, 3,13 hyperthermia, consumption of antiseizure drugs like valproic acid, and lack of folic acid consumption.…”

“…14 Regarding the cause of LMMC, as well as other types of NTDs, it is supported that both environmental and genetic factors play a part in the occurrence of this defect. The environmental risk factors for LMMC might be similar to those for other NTDs including ethnicity, maternal age, 14 obesity, 3,14 diabetes mellitus, 3,13 hyperthermia, consumption of antiseizure drugs like valproic acid, and lack of folic acid consumption. 3 Regarding the effect of folic acid on etiology of LMMC, whereas some studies failed to show any protective role, 6,14 a case-control study in our center indicated a significant correlation between protection from defects and maternal folic acid fortification both before and during the first trimester of pregnancy.…”