Conservative management of asymptomatic spinal lipomas of the conus.
OBJECTIVE
The natural history of spinal lipomas of the conus (SLCs) has not been well studied. Because of disappointing long-term results with early surgical treatment of asymptomatic children with SLCs, we have followed a protocol of conservative management for these patients. The results are presented in this report.


METHODS
Since 1994, all asymptomatic children with SLCs who were examined at Necker-Enfants Malades Hospital were subject to a protocol of conservative management. The records for those patients were reviewed, to determine the incidence and timing of neurological deterioration. The findings were compared with those for a previously reported historical cohort of asymptomatic patients who underwent early surgery at our institution.


RESULTS
Fifty-three asymptomatic children (35 girls and 18 boys) with SLCs were monitored, with conservative management. During a mean follow-up period of 4.4 years (range, 12 mo to 9 yr), 13 patients (25%) exhibited neurological deterioration. At 9 years, the actuarial risks of deterioration, as determined with the Kaplan-Meier method, were 33% for the conservatively treated patients and 46% for the surgically treated patients. With a Cox proportional-hazards model, there was no significant difference in the risks of neurological deterioration for patients who were treated conservatively and those who underwent early surgery.


CONCLUSIONS
The incidences and patterns of neurological deterioration seemed to be very similar, regardless of whether early surgery was performed. These results suggest that conservative treatment of asymptomatic patients is a reasonable option. A more definitive randomized study will be required to clarify the relative efficacy of early surgery for SLCs among asymptomatic patients.
Kulkarni
Abhaya V
AV
Service de Neurochirurgie Pédiatrique, Groupe Hospitalier Necker-Enfants Malades, 149 rue de Sevres, 75743 Paris Cedex 15, France.
Pierre-Kahn
Alain
A
Zerah
Michel
M
D000206:Actuarial Analysis; D000293:Adolescent; D000328:Adult; D002420:Cauda Equina / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D019091:Critical Pathways; D004185:Disability Evaluation; D018450:Disease Progression; D004576:Electromyography; D005260:Female; D005500:Follow-Up Studies; D005602:France; D006801:Humans; D007223:Infant; D008067:Lipoma / Q000151:congenital* / Q000175:diagnosis / Q000628:therapy; D008159:Lumbar Vertebrae / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D009460:Neurologic Examination / Q000706:statistics & numerical data; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data; D010524:Peripheral Nervous System Neoplasms / Q000151:congenital* / Q000175:diagnosis / Q000628:therapy; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012189:Retrospective Studies; D012447:Sacrum / Q000473:pathology; D013120:Spinal Cord Neoplasms / Q000151:congenital* / Q000175:diagnosis / Q000628:therapy; D013125:Spinal Neoplasms / Q000151:congenital* / Q000175:diagnosis / Q000628:therapy; D016019:Survival Analysis; D016896:Treatment Outcome; D014563:Urodynamics / Q000502:physiology