Radical excision of lumbosacral lipoma: An early experience of followers

Abstract

Introduction: Indication, timing and method for surgical treatment of lumbosacral lipoma is controversial. Studies of the natural history of asymptomatic lumbosacral lipoma report that the deterioration rate over 10 years is approximately 35%~45%. Along with this, incidence of neurological or urological complications associated with surgery in the asymptomatic lumbosacral lipoma is about 5%. Radical resection of the lumbosacral lipoma and complete reconstruction of the placode is supported in that better long-term outcome can be achieved with low complication rate. We analyzed the outcomes of lumbosacral lipoma treated with the aggressive untethering and radical excision of fat in the 5 years of initial learning phase. Methods and Results: From November 2009 to December 2014, there were 81 fresh cases of lumbosacral lipoma with dorsal, transitional and chaotic types and true lipomyelomeningocele (LMMC). Caudal and filar types were excluded. Complete untethering was accomplished in 79 cases (98%). Radical excision of the lipoma was attempted in all cases and achieved in 67 cases (83%). Postoperative neurological complication was observed in 8 cases (10%). Out of 8 patients, 4 patients were showed no abnormality on the preoperative examinations. Group of lipoma types (dorsal + transitional vs. chaotic + true LMMC) and availability of radical lipoma excision turn out to be factors related to neurological outcomes in univariate analysis (p<0.001 and p=0.027, respectively). Group of lipoma types, availability of radical excision and postoperative cord/sac ratio are related factors in multivariate analysis (p=0.025, p=0.049 and p=0.031). Conclusions: As a follower of aggressive untethering and radical excision of fat, careful consideration is required to plan the surgical treatment of lumbosacral lipoma on account of the underestimated complication rate. Type of the lipoma is the important factor determining the surgical outcome.