Lumbosacral lipomas: in utero diagnosis and prognosis.
BACKGROUND
For the purposes of prenatal counselling and prognostication, it is essential to keep in mind the key diagnostic criteria allowing recognition of the diverse forms of spinal dysraphism.


METHODS
It is most crucial not to confuse lipomas and myelomeningoceles, the former carrying a usually favourable prognosis, while the latter a high risk of serious neurological deficits. In our experience, these two conditions can be clearly distinguished on prenatal ultrasound and by fetal biology. Lipomas are skin-covered, which explains the normality of the amniotic fluid and probably that of the intracranial content (no Chiari, no hydrocephalus). These features are distinct from those observed in the case of myelomeningoceles. The distinction between a lipoma and a meningocele is more difficult. The prenatal ultrasound presentation of many lipomas actually resembles that of a meningocele. In a few cases, the diagnosis of lipoma can, however, be suspected by the presence of an abnormally thick skin covering and intradural echoic structures that evoke a low-lying cord.


CONCLUSIONS
However, the consequences of confusing a lipoma and most of the other types of occult dysraphism are minimal. Most of these lesions carry a favourable outcome.
Pierre-Kahn
Alain
A
Service de Neurochirurgie Pédiatrique, Groupe Hospitalier Necker-Enfants Malades, 149 rue de Sèvres, 75743 Paris Cedex 15, France. alain.kahn@nck.ap-hop-paris.fr
Sonigo
Pascale
P
D005260:Female; D005333:Fetus; D006801:Humans; D008067:Lipoma / Q000000981:diagnostic imaging*; D008161:Lumbosacral Region / Q000000981:diagnostic imaging / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008588:Meningocele / Q000175:diagnosis; D008591:Meningomyelocele / Q000473:pathology; D011247:Pregnancy; D011379:Prognosis; D013116:Spinal Cord / Q000196:embryology / Q000473:pathology; D016216:Ultrasonography, Prenatal; D014599:Uterus; D000509:alpha-Fetoproteins / Q000032:analysis
D000509:alpha-Fetoproteins