Child's Nervous System

, Volume 35, Issue 9, pp 1591–1597 | Cite as

Radical excision of lumbosacral lipoma: an early experience of “followers”

  • Sangjoon Chong
  • Ji Yeoun Lee
  • Kyung Hyun Kim
  • Hyung-Ik Shin
  • Keewon Kim
  • Kwanjin Park
  • Seung-Ki Kim
  • Kyu-Chang WangEmail author
Original Article



Indication, timing, and method for surgical treatment of lumbosacral lipoma are controversial. Radical resection of the lumbosacral lipoma and complete reconstruction of the placode are supported in that better long-term outcome can be achieved without increasing complication rate compared with traditional surgical techniques.


We analyzed the early surgical outcomes of lumbosacral lipoma treated with the untethering and radical excision of fat.


Retrospective analysis of surgically treated 81 fresh lumbosacral lipoma cases with dorsal, transitional, and chaotic types and true lipomyelomeningocele (LMMC) was performed. Caudal and filar types were excluded.


Complete untethering was accomplished in 98%. Radical excision of the lipoma was attempted in all cases and achieved in 83%. Postoperative neurological complication was observed in 8 cases (10%). 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/dural sac (C/D) ratio are related factors in multivariate analysis (p = 0.025, p = 0.049, and p = 0.031).


As a follower of untethering and radical excision of fat, careful consideration is required to plan the surgery of lumbosacral lipoma on account of the “underestimated” complication rate. Type of the lipoma is the important factor determining the surgical outcome. Availability of complete radical excision and postoperative C/D ratio are the operative factors related to the neurological outcomes.


Lumbosacral lipoma Neurological outcome Radical excision Complications Untethering 



This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT & Future Planning (2015R1A2A1A15055781).

Compliance with ethical standards

This study was approved by the Institutional Review Board (IRB) of the hospital. The waiver of consent was granted under IRB review.

Conflict of interest

There are no conflicts of interests.


  1. 1.
    Arai H, Sato K, Okuda O, Miyajima M, Hishii M, Nakanishi H, Ishii H (2001) Surgical experience of 120 patients with lumbosacral lipomas. Acta Neurochir 143:857–864CrossRefGoogle Scholar
  2. 2.
    Blount JP, Elton S (2001) Spinal lipomas. Neurosurg Focus 10:e3CrossRefGoogle Scholar
  3. 3.
    Chapman PH (1982) Congenital intraspinal lipomas: anatomic considerations and surgical treatment. Childs Brain 9:37–47Google Scholar
  4. 4.
    Holly LT, Batzdorf U (2002) Slitlike syrinx cavities: a persistent central canal. J Neurosurg 97:161–165CrossRefGoogle Scholar
  5. 5.
    Hwang H, Wang KC, Bang MS, Shin HI, Kim SK, Phi JH, Lee JY, Choi J, Cha S, Kim K (2017) Optimal stimulation parameters for intraoperative bulbocavernosus reflex in infants. J Neurosurg Pediatr 20:464–470. CrossRefGoogle Scholar
  6. 6.
    Kothbauer K, Schmid UD, Seiler RW, Eisner W (1994) Intraoperative motor and sensory monitoring of the cauda equina. Neurosurgery 34:702–707 discussion 707Google Scholar
  7. 7.
    Krassioukov AV, Sarjeant R, Arkia H, Fehlings MG (2004) Multimodality intraoperative monitoring during complex lumbosacral procedures: indications, techniques, and long-term follow-up review of 61 consecutive cases. J Neurosurg Spine 1:243–253. CrossRefGoogle Scholar
  8. 8.
    Kulkarni AV, Pierre-Kahn A, Zerah M (2004) Conservative management of asymptomatic spinal lipomas of the conus. Neurosurgery 54:868–873; discussion 873–875Google Scholar
  9. 9.
    Lee JY, Phi JH, Cheon JE, Kim SK, Kim IO, Cho BK, Wang KC (2012) Preuntethering and postuntethering courses of syringomyelia associated with tethered spinal cord. Neurosurgery 71:23–29. CrossRefGoogle Scholar
  10. 10.
    Lee JY, Phi JH, Kim SK, Cho BK, Wang KC (2011) Urgent surgery is needed when cyst enlarges in terminal myelocystoceles. Childs Nerv Syst 27:2149–2153. CrossRefGoogle Scholar
  11. 11.
    Pang D (2015) Total resection of complex spinal cord lipomas: how, why, and when to operate? Neurol Med Chir (Tokyo) 55:695–721. CrossRefGoogle Scholar
  12. 12.
    Pang D, Zovickian J, Oviedo A (2009) Long-term outcome of total and near-total resection of spinal cord lipomas and radical reconstruction of the neural placode: part I-surgical technique. Neurosurgery 65:511–528; discussion 528–529.
  13. 13.
    Pang D, Zovickian J, Oviedo A (2010) Long-term outcome of total and near-total resection of spinal cord lipomas and radical reconstruction of the neural placode, part II: outcome analysis and preoperative profiling. Neurosurgery 66:253–272; discussion 272–273.
  14. 14.
    Paradiso G, Lee GY, Sarjeant R, Hoang L, Massicotte EM, Fehlings MG (2006) Multimodality intraoperative neurophysiologic monitoring findings during surgery for adult tethered cord syndrome: analysis of a series of 44 patients with long-term follow-up. Spine (Phila Pa 1976) 31:2095–2102. CrossRefGoogle Scholar
  15. 15.
    Pierre-Kahn A, Zerah M, Renier D, Cinalli G, Sainte-Rose C, Lellouch-Tubiana A, Brunelle F, Le Merrer M, Giudicelli Y, Pichon J, Kleinknecht B, Nataf F (1997) Congenital lumbosacral lipomas. Childs Nerv Syst 13:298–334; discussion 335CrossRefGoogle Scholar
  16. 16.
    Wykes V, Desai D, Thompson DN (2012) Asymptomatic lumbosacral lipomas--a natural history study. Childs Nerv Syst 28:1731–1739. CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Sangjoon Chong
    • 1
    • 2
  • Ji Yeoun Lee
    • 2
    • 3
  • Kyung Hyun Kim
    • 2
  • Hyung-Ik Shin
    • 4
  • Keewon Kim
    • 4
  • Kwanjin Park
    • 5
  • Seung-Ki Kim
    • 2
  • Kyu-Chang Wang
    • 2
    Email author
  1. 1.Department of NeurosurgeryAsan Medical CenterSeoulRepublic of Korea
  2. 2.Division of Pediatric NeurosurgerySeoul National University Children’s HospitalSeoulRepublic of Korea
  3. 3.Department of Anatomy, College of MedicineSeoul National UniversitySeoulRepublic of Korea
  4. 4.Department of Rehabilitation MedicineSeoul National University HospitalSeoulRepublic of Korea
  5. 5.Department of UrologySeoul National University HospitalSeoulRepublic of Korea

Personalised recommendations