title: Radiological findings and clinical course of conus lipoma: implications for surgical treatment.
abstract: OBJECTIVE
  A significant variety in morphology of conus lipomas may underlie differences in clinical presentation of the patients and controversy in surgical management. We retrospectively studied 58 patients with conus lipomas at our institutions. The purpose of this study was to infer the clinical course from the radiological findings and to provide information for decision-making in planning for surgical treatment.
  
  
  METHODS
  The patients underwent untethering surgery between 1984 and 2005. There were 35 transitional and 23 dorsal lipomas. The age at surgery ranged from 1 month to 50 years (median, 4 yr). Preoperative clinical history, radiological findings, and postoperative results were analyzed.
  
  
  RESULTS
  Fifteen patients were asymptomatic, and 43 patients were symptomatic preoperatively. Twenty-one patients presented with motor deficits of the lower extremities. In seven patients, motor deficits appeared early, before 1 year of age. Massive lipomas compressing the cord or herniation of the spinal cord into the subcutaneous tissue were characteristic findings of such early deterioration. Motor deficits were present in 73% of patients with lipomas extending to the lumbar level, whereas 88% of patients with lipomas confined to the sacral level had only urinary deficits. During a mean postoperative follow-up period of 7.9 years, 4 (27%) of the 15 asymptomatic patients developed urinary and/or motor deficits, and 12 (28%) of the 43 symptomatic patients showed further neurological deterioration.
  
  
  CONCLUSIONS
  This study demonstrates that the location and morphology of conus lipomas influence the neurological presentation of the patients. Early prophylactic surgery is a reasonable treatment option if early deterioration is predicted by imaging studies.
authors.affiliation: Department of Neurosurgery, Sapporo Medical University School of Medicine, Chuo-ku, Sapporo, Japan. koyai@sapmed.ac.jp
authors.forename: Izumi
authors.initials: I
authors.lastname: Koyanagi
authors.forename: Kazutoshi
authors.initials: K
authors.lastname: Hida
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Iwasaki
authors.forename: Toyohiko
authors.initials: T
authors.lastname: Isu
authors.forename: Masami
authors.initials: M
authors.lastname: Yoshino
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Murakami
authors.forename: Kazuhisa
authors.initials: K
authors.lastname: Yoshifuji
authors.forename: Kiyohiro
authors.initials: K
authors.lastname: Houkin
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007796:Laminectomy / Q000379:methods; D008067:Lipoma / Q000000981:diagnostic imaging* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods; D011859:Radiography; D012189:Retrospective Studies; D013120:Spinal Cord Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery*; D055815:Young Adult