Late effects of early surgery on lipoma and lipomeningocele in children less than 1 year old.
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).
Satar
N
N
Department of Neurosurgery, Children's Hospital, Boston, Massachusetts 02115, USA.
Bauer
S B
SB
Scott
R M
RM
Shefner
J
J
Kelly
M
M
Darbey
M
M
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