Long-Term Outcome of Total and Near-Total Resection of Spinal Cord Lipomas and Radical Reconstruction of the Neural Placode

Pang, Dachling; Zovickian, John; Oviedo, Angélica

doi:10.1227/01.neu.0000350879.02128.80

Cited by 140 publications

(146 citation statements)

References 43 publications

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“…Radical resection of the spinal lipoma, first introduced in April 2009 in this series, was also analyzed using the new classification. 16,18,19 New Classification System Used in this Study Type 1: Primary Neurulation Failure Only Type 1 spinal lipoma is a typical form in which the lipoma-cord interface occurs on the dorsal surface of the spinal cord, while the conus medullaris is located distally or ventrally with respect to the caudal end of the lipoma. The subcutaneous fat mass penetrates the fascia and reaches the dorsal surface of the dura through the pathological spina bifida.…”

Section: Spinal Lipoma Classificationmentioning

confidence: 99%

“…Pang later added the chaotic lipoma associated with the embryological stage between the transitional and terminal lipomas. 18,20 The difference between the previous and new classifications is shown in Fig. 8.…”

Section: Classification Of Spinal Lipomasmentioning

confidence: 99%

“…Surgical intervention is moderately difficult, but radical resection is possible since the fusion line exists. 15,16,18,20 Since Type 1 spinal lipoma develops only within a narrow time frame at the end of primary neurulation, association with other anomalies is rare, as can be seen in Table 2.…”

Section: Clinical and Surgical Implicationsmentioning

confidence: 99%

“…Radical resection is not indicated. 15,16,18,20 Type 3 spinal lipoma has little or no skin stigmata. Physiological spina bifida is present, but there is no pathological spina bifida.…”

Section: Clinical and Surgical Implicationsmentioning

confidence: 99%

“…28 Surgically orientated classification of spinal lipoma was first proposed by Chapman and underwent various modifications based on MRI findings. 1,2,8,16,18 Chapman's classification is still useful today but does not account for spinal lipomas originating from failed secondary neurulation. Some have included the filum lipoma in the classification.…”

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confidence: 99%

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New classification of spinal lipomas based on embryonic stage

Morota

Ihara

Ogiwara

2017

PED

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OBJECTIVE Spinal lipomas are generally thought to occur as a result of failed primary neurulation. However, some clinical features cannot be explained by this theory. The authors propose a novel classification of spinal lipomas based on embryonic changes seen during primary and secondary neurulation. METHODS A total of 677 patients with occult spinal dysraphism underwent 699 surgeries between August 2002 and May 2015 at the National Center for Child Health and Development and Tokyo Metropolitan Children's Medical Center. This group of patients had 378 spinal lipomas, including 119 conus spinal lipomas, 27 lipomyelomeningoceles, and 232 filum lipomas, which the authors classified into 4 types based on neural tube formation during embryonic development. Type 1 is defined as pure primary neurulation failure; Type 2 ranges from primary to secondary neurulation failure; Type 3 consists of secondary neurulation failure (early phase); and Type 4 is defined as secondary neurulation failure (late phase). The authors also review embryogenesis in secondary neurulation and analyze the clinical utility of the new classification. RESULTS There were 55 Type 1 spinal lipomas, 29 Type 2, 62 Type 3, and 232 Type 4. All filum lipomas fell into the Type 4 spinal lipoma category. Association with anorectal and/or sacral anomalies was seen in none of the Type 1 cases, 15 (52%) of Type 2, 35 (56%) of Type 3, and 31 (13%) of Type 4. Urogenital anomalies were observed in none of the Type 1 or Type 2 cases, 1 (2%) of Type 3, and 28 (12%) of Type 4. Anomaly syndromes were present in none of the Type 1 cases, 6 (21%) of Type 2, 3 (5%) of Type 3, and 16 (7%) of Type 4. Associated anomalies or anomaly syndromes were clearly observed only for Type 2–4 spinal lipomas encompassing failed secondary neurulation. Radical resection was feasible for Type 1 spinal lipomas. CONCLUSIONS Secondary neurulation of the spinal cord gives rise to the conus medullaris and filum terminale, which are often involved in spinal lipomas. Formation of spinal lipomas seems to be a continuous process overlapping primary and secondary neurulation in some cases. Association with other anomalies was higher in Type 2–4 spinal lipomas, which included failed secondary neurulation, than in Type 1 lipomas, with failed primary neurulation. On the other hand, radical resection was indicated for Type 1, but not for Type 2, spinal lipomas. The new classification of spinal lipomas based on embryonic stage has the potential for clinical use and agrees well with both clinical and surgical findings. The classification proposed here is still preliminary. Further studies and verification are necessary to establish its clinical utility.

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Section: Spinal Lipoma Classificationmentioning

confidence: 99%

Section: Classification Of Spinal Lipomasmentioning

confidence: 99%

Section: Clinical and Surgical Implicationsmentioning

confidence: 99%

“…Radical resection is not indicated. 15,16,18,20 Type 3 spinal lipoma has little or no skin stigmata. Physiological spina bifida is present, but there is no pathological spina bifida.…”

Section: Clinical and Surgical Implicationsmentioning

confidence: 99%

mentioning

confidence: 99%

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New classification of spinal lipomas based on embryonic stage

Morota

Ihara

Ogiwara

2017

PED

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Evaluation and management of tethered cord syndrome in occult spinal dysraphism: Recommendations from the international children's continence society

Tuite

Thompson

Austin

et al. 2017

Neurourology and Urodynamics

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Infants with classic cutaneous markers of OSD, with progressive neurologic, skeletal, and/or urologic findings, present no diagnostic or therapeutic dilemma: they routinely undergo MRI and SCU. Conversely, in asymptomatic patients or those with fixed, minor abnormalities, the risk profile of these OSD cohorts should be carefully considered before SCU is performed. Irrespective of whether or not SCU is performed, patients at risk for progression should be followed carefully throughout childhood and adolescence by a multidisciplinary team.

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Lipomyelomeningoceles

Blount¹,

Dupépé²

2019

Occult Spinal Dysraphism

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Long-Term Outcome of Total and Near-Total Resection of Spinal Cord Lipomas and Radical Reconstruction of the Neural Placode

Cited by 140 publications

References 43 publications

New classification of spinal lipomas based on embryonic stage

New classification of spinal lipomas based on embryonic stage

Evaluation and management of tethered cord syndrome in occult spinal dysraphism: Recommendations from the international children's continence society

Lipomyelomeningoceles

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