title: Asymptomatic lipomas of the medullary conus: surgical treatment versus conservative management.
abstract: OBJECTIVE
  The goal of this study was to compare long-term results of surgery with the outcomes of conservative treatment in patients with asymptomatic lipomas of the conus medullaris.
  
  
  METHODS
  The parents of 56 consecutive children with a diagnosis of asymptomatic lipoma of the conus medullaris underwent detailed neurosurgical consultation. The pros and cons of both prophylactic surgery and conservative treatment were carefully presented. Both options were offered, and the parents were free to choose the preferred management. A total of 32 children underwent surgical treatment, and 24 were conservatively treated. Afterward, all patients entered the same protocol of serial neurological and urological follow-up at the Centro Spina Bifida. The mean follow-up periods were 9.7 years in the surgical treatment group and 10.4 years in the conservative treatment group.
  
  
  RESULTS
  Permanent surgical morbidity was 3.1% (1 patient). During follow-up, tethered cord syndrome occurred in 9.7% of the surgically treated patients (3 of 32 patients) and in 29.1% of the conservatively managed children (7 of 24 patients). This difference did not result in statistical significance, but a clear trend in favor of surgery emerged. Young age at surgery and a cord/sac ratio < 50% appeared to be determining factors in the prevention of subsequent tethered cord syndrome.
  
  
  CONCLUSIONS
  The small size of this series does not provide enough statistical evidence that surgical treatment can really improve the natural history of asymptomatic lipomas of the conus medullaris. Nevertheless, surgery appears at least advisable since it reduces by 75% the odds of TCS (p = 0.067), which is quite close to statistical significance.
authors: Department of Neurosurgery.
authors: Giuseppe
authors: G
authors: Talamonti
authors: Giuseppe
authors: G
authors: D'Aliberti
authors: Michele
authors: M
authors: Nichelatti
authors: Alberto
authors: A
authors: Debernardi
authors: Marco
authors: M
authors: Picano
authors: Tiziana
authors: T
authors: Redaelli
mesh_terms: D000367:Age Factors; D000553:Ambulatory Care / Q000379:methods; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D005260:Female; D005500:Follow-Up Studies; D020233:Gait Disorders, Neurologic / Q000209:etiology; D006801:Humans; D007223:Infant; D007558:Italy; D053208:Kaplan-Meier Estimate; D008067:Lipoma / Q000175:diagnosis / Q000601:surgery / Q000628:therapy*; D008279:Magnetic Resonance Imaging; D008297:Male; D059352:Musculoskeletal Pain / Q000209:etiology; D009436:Neural Tube Defects / Q000209:etiology / Q000517:prevention & control*; D059906:Neuroimaging / Q000379:methods; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods; D011322:Primary Prevention / Q000379:methods; D012017:Referral and Consultation; D018401:Sample Size; D012585:Sciatica / Q000209:etiology; D013116:Spinal Cord / Q000473:pathology* / Q000503:physiopathology; D013120:Spinal Cord Neoplasms / Q000175:diagnosis / Q000517:prevention & control / Q000601:surgery / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D014563:Urodynamics
keywords: LCM = lipoma of the conus medullaris; TCS = tethered cord syndrome; conus medullaris; lipoma; natural history; pediatric neurosurgery; spinal dysraphism; spine; tethered cord syndrome