title: Spinal lipoma of the filum terminale: review of 174 consecutive patients.
abstract: OBJECTIVE
  Spinal lipoma of the filum terminale (LFT) is a congenital lumbosacral anomaly that can cause tethered cord syndrome. Purposes of this study are to clarify preoperative characteristics of LFT, to elucidate surgical effects, and to discuss the rationale of prophylactic surgery for LFT.
  
  
  METHODS
  Medical data of 174 children (2008-2014) who underwent section of LFT were prospectively recorded for prevalence of symptoms, skin stigmas, and associated malformations, motivator of diagnosis, conus level, and surgical outcome. Mean age at surgery was 4.1 ± 4.2 years (37 days to 17.7 years).
  
  
  RESULTS
  Ninety-four children (54.0 %) had skin stigmas and 60 (34.5 %) had certain perineal malformations. Seventy-nine children (45.4 %) were symptomatic. The most common motivator for diagnosis was skin stigmas (44.3 %), followed by associated malformations (33.3 %), and symptoms (20.1 %). The age at surgery was significantly older in symptomatic patients than in asymptomatic patients (p < 0.001). Surgery improved symptoms in 50 % of patients at 2.1-year follow-up period. Of 85 asymptomatic patients, all except one remained asymptomatic postoperatively and none of the symptomatic patients deteriorated. The presence of associated malformations and the conus level did not affect surgical outcome. Postoperative complications developed in nine patients (5.2 %): seven transient local problems, one definitive urological deterioration, and one transient respiratory problem.
  
  
  CONCLUSIONS
  Surgery for LFT was a simple and safe procedure. It improved half of symptomatic patients and stopped the deterioration of the others. Even if only one of the asymptomatic patients deteriorated at maximum follow-up, the role of prophylactic surgery remains a point of discussion.
authors.affiliation: Department of Pediatric Neurosurgery, Necker-Enfants Malades Hospital, Assistance Publique Hopitaux de Paris, Paris V University, 149 rue de Sèvres, 75015, Paris, France.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Usami
authors.affiliation: Department of Pediatric Rehabilitation, Trousseau Hospital, Paris, France.
authors.forename: Pauline
authors.initials: P
authors.lastname: Lallemant
authors.affiliation: Department of Pediatric Neurosurgery, Necker-Enfants Malades Hospital, Assistance Publique Hopitaux de Paris, Paris V University, 149 rue de Sèvres, 75015, Paris, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Roujeau
authors.affiliation: Department of Pediatric Neurosurgery, Necker-Enfants Malades Hospital, Assistance Publique Hopitaux de Paris, Paris V University, 149 rue de Sèvres, 75015, Paris, France.
authors.forename: Syril
authors.initials: S
authors.lastname: James
authors.affiliation: Department of Pediatric Neurosurgery, Necker-Enfants Malades Hospital, Assistance Publique Hopitaux de Paris, Paris V University, 149 rue de Sèvres, 75015, Paris, France.
authors.forename: Kevin
authors.initials: K
authors.lastname: Beccaria
authors.affiliation: Department of Pediatric Radiology, Necker-Enfants Malades Hospital, Paris, France.
authors.forename: Raphael
authors.initials: R
authors.lastname: Levy
authors.affiliation: Department of Pediatric Neurosurgery, Necker-Enfants Malades Hospital, Assistance Publique Hopitaux de Paris, Paris V University, 149 rue de Sèvres, 75015, Paris, France.
authors.forename: Federico
authors.initials: F
authors.lastname: Di Rocco
authors.affiliation: Department of Pediatric Neurosurgery, Necker-Enfants Malades Hospital, Assistance Publique Hopitaux de Paris, Paris V University, 149 rue de Sèvres, 75015, Paris, France.
authors.forename: Christian
authors.initials: C
authors.lastname: Sainte-Rose
authors.affiliation: Department of Pediatric Neurosurgery, Necker-Enfants Malades Hospital, Assistance Publique Hopitaux de Paris, Paris V University, 149 rue de Sèvres, 75015, Paris, France. michel.zerah@gmail.com.
authors.forename: Michel
authors.initials: M
authors.lastname: Zerah
mesh_terms: D000293:Adolescent; D002420:Cauda Equina / Q000000981:diagnostic imaging / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008067:Lipoma / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D012867:Skin / Q000473:pathology; D013125:Spinal Neoplasms / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D016896:Treatment Outcome
keywords: Occult spinal dysraphism; Prophylactic surgery; Surgical outcome; Tethered cord syndrome