title: Late effects of early surgery on lipoma and lipomeningocele in children less than 1 year old.
abstract: OBJECTIVE
  We attempted to assess the usefulness of urodynamic testing for diagnosing lipoma and lipomeningocele, and the late effects of early neurosurgical intervention in children less than 1 year old.
  
  
  METHODS
  A total of 28 patients in whom spinal surgery was performed before age 1 year for correcting lipoma and lipomeningocele underwent neurological and urodynamic evaluation preoperatively, and within 3 months and up to 14.5 years postoperatively.
  
  
  RESULTS
  Preoperatively 15 patients (54%) had an abnormal neurological examination and 7 had an abnormal urodynamic study. Of the 13 patients with a normal neurological examination 3 had an abnormal urodynamic study. Overall 10 patients (37%) had an abnormal urodynamic examination preoperatively. Immediately after surgery 8 patients (29%) had improvement (2 of 15 with an abnormal neurological examination and 6 of 10 with an abnormal urodynamic study), whereas the condition of 9 (32%) worsened, including 4 of the 13 who were neurologically and 6 of the 18 who were urodynamically normal (1 in both categories). With time an additional 7 patients (25%) had progressive deterioration, including 6 urodynamically and 5 neurologically (4 in both categories), 2 (7%) had improvement (1 each urodynamically and neurologically) and the condition of 19 (68%) remained stable. Six patients (21%) underwent secondary spinal surgery for recurrent tethering.
  
  
  CONCLUSIONS
  Early surgical repair seems to provide a degree of protection against later spinal cord tethering, and subsequent neurological and/or urodynamic deterioration (25% of our patients versus a reported 80% of those followed expectantly).
authors.affiliation: Department of Neurosurgery, Children's Hospital, Boston, Massachusetts 02115, USA.
authors.forename: N
authors.initials: N
authors.lastname: Satar
authors.forename: S B
authors.initials: SB
authors.lastname: Bauer
authors.forename: R M
authors.initials: RM
authors.lastname: Scott
authors.forename: J
authors.initials: J
authors.lastname: Shefner
authors.forename: M
authors.initials: M
authors.lastname: Kelly
authors.forename: M
authors.initials: M
authors.lastname: Darbey
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008067:Lipoma / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008588:Meningocele / Q000503:physiopathology / Q000601:surgery*; D011182:Postoperative Care; D011300:Preoperative Care; D013120:Spinal Cord Neoplasms / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D014563:Urodynamics