Total Resection of Complex Spinal Cord Lipomas: How, Why, and When to Operate?

Neurologia Medico-chirurgica
Dachling Pang

Abstract

This article shows the long-term advantage of total resection of complex spinal cord lipomas over partial resection and over non-surgical treatment for children with asymptomatic lipomas. The classification, embryogenesis, and technique of total resection of complex lipomas are described. The 20-year outcome of 315 patients who had total resection is measured by overall progression-free survival (PFS, Kaplan-Meier), and by subgroup Cox multivariate hazard analysis for the influence of four variables: lipoma type, symptoms, prior surgery, and post-operative cord-sac ratio. These results are compared to 116 patients who underwent partial resection, and to two published series of asymptomatic lipomas followed without surgery. The PFS after total resection for all lipomas is 88.1% over 20 years vs. 34.6% for partial resection at 10.5 years (p < 0.0001). The PFS for total resection of asymptomatic virgin lipomas rose to 98.8% vs. 60% and 67% for non-surgical treatment. Partial resection also compares poorly to non-surgical treatment for asymptomatic lipomas. Multivariate analyses show that a low cord-sac ratio is the only independent variable that predicts good outcome. Pre-operative profiling shows the ideal patient for total resec...Continue Reading

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Citations

Jan 28, 2017·Journal of Neurosurgery. Pediatrics·Nobuhito MorotaHideki Ogiwara
Mar 30, 2018·Child's Nervous System : ChNS : Official Journal of the International Society for Pediatric Neurosurgery·Victoria Jones, Dominic Thompson
Feb 20, 2018·Neurosurgical Review·Malte OttenhausenAndreas Jödicke
Jun 4, 2019·Child's Nervous System : ChNS : Official Journal of the International Society for Pediatric Neurosurgery·Sangjoon ChongKyu-Chang Wang
Feb 27, 2017·Child's Nervous System : ChNS : Official Journal of the International Society for Pediatric Neurosurgery·Thomas RoujeauMichel Zerah
May 13, 2020·Journal of Korean Neurosurgical Society·Dachling Pang
Aug 10, 2019·BMC Neurology·Luca MassimiMassimo Caldarelli
Jul 31, 2020·Child's Nervous System : ChNS : Official Journal of the International Society for Pediatric Neurosurgery·Laura Grazia ValentiniGiorgio Selvaggio

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Methods Mentioned

BETA
dissection
dissection.
dissecting
total resection
prophylactic surgery
for
prophylactic

Software Mentioned

Cascade

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