Management of lipomyelomeningoceles

TLDR

Patients with lipomyelomeningoceles often seek treatment because the back mass has a noticeable cosmetic effect. The authors reviewed 97 children operated on between 1960 and 1982, noting that most presented before 6 months of age and received early untethering with dural grafting, while older patients were more likely to have delayed or inadequate surgery. Early appropriate surgery prevented neurological decline in most patients, whereas delayed or improper treatment led to significant sequelae such as urinary incontinence, leg deformity, and gross neurological impairment.

Abstract

✓ Ninety-seven children with lipomyelomeningoceles were operated on at the Hospital for Sick Children between January, 1960, and December, 1982. The most common factor that caused these patients to seek help was the cosmetic effect of the mass on their back. However, 22 patients had urinary incontinence and 15 patients had a deformed or weak leg. Sixty of the 97 patients were female and 37 were male. The patients presented for treatment between 6 days and 18½ years of age with a median age of 7½ months. Fifty-six patients presented before the age of 6 months and 35 of these were perfectly normal at the time of presentation. On the other hand, of the 41 patients who were brought for treatment after the age of 6 months, only 12 were normal prior to surgery. When patients were appropriately treated at an early age, with their spinal cords untethered and their dura securely closed with a dural graft, then they remained unchanged neurologically or even improved. However, when treatment was delayed or not done appropriately then they were left with significant neurological sequelae. Lipomyelomeningoceles are serious lesions which without appropriate therapy can result in gross impairment of neurological function.