Lipomyelomeningocele: Pathology, Treatment, and Outcomes

A Review

Christina E. Sarris, B.S; Krystal L. Tomei, M.D., M.P.H; Peter W. Carmel, M.D; Chirag D. Gandhi, M.D.

Disclosures

Neurosurg Focus. 2012;33(4):e3 

In This Article

Outcomes

Risks of surgery include CSF leakage; neurological deterioration either secondary to nerve injury during surgery or as a result of tethered cord; and incomplete wound healing or wound breakdown, infection, and meningitis. The overall complication rate of surgery is between 10% and 30%.[2,34] In a series of 120 patients, worse neurological function was found in 5.8% of patients after primary surgery.[2] The incidence of spinal cord retethering following lipomyelomeningocele resection has been found to be between 10% and 20%.[11,27,34,55] Retethering may present first with back pain and deterioration of lower-extremity function followed by worsening urological and bowel function, generally occurring 3–8 years after the initial surgery.[2,10]

Outcomes after surgery for lipomyelomeningocele are dependent on the preoperative function of the patient. A series of 80 patients demonstrated that 92.1% of children with a normal preoperative examination had no neurological deficits or bladder dysfunction at long-term follow-up, and all had normal bladder function. However, none of the children with preoperative bowel and bladder paralysis recovered normal function, despite improvement in sensory and motor deficits in this subgroup. Bowel and bladder paralysis remained the greatest morbidity of this series, with complications of recurrent urinary tract infection and pyelonephritis.[34]

Another series of 120 patients who underwent surgery for lipomyelomeningocele demonstrated improvement in functional grade (a grading system incorporating neurological, urological, and orthopedic deficits) in 10% of patients and deterioration in 5.8%, with the remainder maintaining the same functional grade. Those patients whose conditions deteriorated the most commonly displayed worsening bowel and bladder function.[2] A series of 43 patients demonstrated that 84% of patients maintained stable urodynamic and neurological function after surgery and noted the primary predictor of normal bladder function in the long term was normal preoperative urodynamic status.[70]

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