Early Neurological Outcome of Surgical Repair of Lipomyelomeningocele in Infants
Objective: A prospective cohort study was aimed to evaluate the early neurological outcome of surgery among infants having lipomyelomeningocele.
Material and Methods: The study was conducted at the Department of Pediatric neurosurgery, Children Hospital &The Institute of Child Health, Lahore from January 2019 to June 2019.A total of 50 pediatric patients, both male and female, aged 3 months to 1 year, with lipomyelomeningocele (symptomatic or asymptomatic) who presented to the out-patient department were included in the study. Group A included those cases who were aged <6 months and Group B were aged >6 months. All patients underwent standard surgical procedures for the treatment of lipomyelomeningocele.
Results: Out of a total of 50 infants, there was 32 (64.0%) female. Overall, the mean age was 7.39 ± 2.63 months. The lumbar area having mass on the back was the most frequently seen in 23 (46.0%) infants. Group A included 20 (40.0%) infants while Group-B had 30 (60.0%). Low lying cord was the commonest neurological finding noted among 25 (50.0%). Complete Excision of Lipoma was done among 48 (96.0%) infants. Post-surgery, no significant difference was found on day-3 and day-10 between study groups (P > 0.05). Early outcome at 6-months intervals was found to be associated with significantly improved neurological function grades in Group-A (p = 0.030).
Conclusion: Surgical management of lipomyelomeningocele is a safe procedure. An early treatment approach even in asymptomatic infants is recommended to reduce neurological deterioration.
2. Forrester MB, Merz RD. Descriptive epidemiology of lipomyelomeningocele, Hawaii, 1986–2001. Birth Defects Research Part A: Clinical and Molecular Teratology, 2004; 70 (12): 953-6.
3. Warder DE. Tethered cord syndrome and occult spinal dysraphism. Neurosurg Focus, 2001; 10: e1.
4. Hoffman HJ, Taecholarn C, Hendrick EB, Humphreys RP. Management of lipomyelomeningoceles. Experience at the hospital for sick children, Toronto. J Neurosurg. 1985; 62: 1–8.
5. Frey L, Hauser WA. Epidemiology of neural tube defects. Epilepsia, 2003; 44 (Suppl. 3): 4–13.
6. McNeely PD, Howes WJ. Ineffectiveness of dietary folic acid supplementation on the incidence of lipomyelomeningocele: Pathogenetic implications. J Neurosurg. 2004; 100 (2 Suppl): 98–100.
7. Hertzler DA, 2nd, DePowell JJ, Stevenson CB, Mangano FT. Tethered cord syndrome: A review of the literature from embryology to adult presentation. Neurosurg Focus, 2010; 29: e1.
8. Huang SL, Shi W, Zhang LG. Surgical treatment for lipomyelomeningocele in children. World J Pediatr. 2010; 6: 361–5.
9. Kanev PM, Lemire RJ, Loeser JD, Berger MS. Management and long-termfollow-up review of childrenwith lipomyelomeningocele, 19521987. J Neurosurg. 1990; 73: 48–52.
10. Hashim ASM, Ahmed S, Jooma R. Management of myelocele. J Surg Pakistan (International), 2008; 13 (1): 7-11.
11. Patil PS, Abhaya Gupta. Immediate and long term outcome analysis of lipomeningomyelocele repair in asymptomatic infants in a tertiary care center. J Pediatr Neurosci. 2016; 11 (2): 99–104
12. Muthukumar N. Congenital spinal lipomatos malformations: Part I – Classification. Acta Neurochir .2009; 151: 179-88.
13. Koirala PR, Pradhanang AB, Sedain G, Sharma MR. Outcome Analysis of Lipomeningomyelocele Repair in Children in a Tertiary Care Center in Nepal. JOIM Nepal, 2019; 41 (2): 30-34.
14. Wagner KM, Raskin JS, Hansen D, Reddy GD, Jea A, Lam S. Surgical management of lipomyelomeningocele in children: Challenges and considerations. Surg Neurol Int. 2017; 8: 63.
15. Yerkes EB, Halline C, Yoshiba G, Meyer TA, Rosoklija I, Bowman R, et al. Lipomyelomeningocele for the urologist: Should we view it the same as myelomeningocele? J Pediatr Urol. 2017; 13 (4): 371.e1-371.e8.
16. Kulkarni AV, Pierre-Kahn A, Zerah M. Conservative management of asymptomatic spinal lipomas of the conus. Neurosurgery, 2004; 54: 868-73.
17. Pierre-Kahn A, Lacombe J, Pichon J, et al. Intraspinal lipomas with spina bifida. Prognosis and treatment in 73 cases. J Neurosurg. 1986; 65: 756–61.
18. Pang D, Zovickian J, Wong ST, et al. Surgical treatment of complex spinal cord lipomas. Childs Nerv Syst. 2013; 29: 1485-13.
19. Huang SL, Shi W, Zhang LG. Surgical methods and techniques of lipomyelomeningocele in children. Zhonghua WaiKe ZaZhi. 2010; 48 (10): 750-2.
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