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Does conus morphology have implications for outcome in lumbosacral lipoma?

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Abstract

Objective

Lumbosacral lipomas (LSL) of the ‘dorsal’ type have been associated with more favourable outcomes compared with other conus region lipomas. We hypothesised that integrity of the conus on MRI underpins the improved prognosis in this subgroup of LSL patients.

Methods

The definition of ‘dorsal lipomas’ included lipomas with attachment to the conus, but where the conus could be delineated on MRI (Morota type 1) as reported by Morota et al. (J Neurosurg Pediatr 19:428–439, 2017). Additional inclusion criteria included asymptomatic status at presentation, age >3 years at follow-up, and neurological and urological evaluation at presentation and at last follow-up. Lipoma extent and conus level were recorded. Outcome measures were the need for untethering surgery and neuro-urological status at last follow-up. Urological outcomes were defined by continence and efficacy of bladder emptying.

Results

Twenty-six children were included (median age 8.7 years). Conus level was low (at or below L2) in 92%. Nine required untethering surgery: 5 prophylactic, 4 because of clinical deterioration. Twenty-five children were continent at last follow-up, one had stress incontinence, and none required catheterisation. One had persisting ankle weakness after surgery requiring orthotic support.

Conclusions

In LSL of the conus, visualisation of the conus on MRI is associated with good urological and motor outcomes. The integrity of the conus appears to be a more important prognostic factor than anatomical level. An observational approach to this group of LSL patients does not appear to compromise outcomes. These findings support a selective approach to untethering surgery.

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Authors and Affiliations

  1. Department of Paediatric Neurosurgery, Great Ormond Street Hospital for Children NHS Trust, London, UK

    Dominic N. P. Thompson, Jochem Spoor, Martje Schotman & Claudia L. Craven

  2. Department of Paediatric Neurosurgery, Erasmus MC Sophia Children’s Hospital, Rotterdam, The Netherlands

    Jochem Spoor

  3. Department of Urology, Haga Hospitals, The Hague, The Netherlands

    Martje Schotman

  4. Department of Paediatric Urology, Great Ormond Street Hospital for Children NHS Trust, London, UK

    Susan Maestri & Divyesh Desai

Authors
  1. Dominic N. P. Thompson
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  2. Jochem Spoor
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  3. Martje Schotman
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  4. Susan Maestri
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  5. Claudia L. Craven
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  6. Divyesh Desai
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Correspondence to Dominic N. P. Thompson.

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Thompson, D.N.P., Spoor, J., Schotman, M. et al. Does conus morphology have implications for outcome in lumbosacral lipoma?. Childs Nerv Syst 37, 2025–2031 (2021). https://doi.org/10.1007/s00381-021-05081-3

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  • DOI: https://doi.org/10.1007/s00381-021-05081-3

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