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The Current Status of the Surgical Management of Complex Spinal Cord Lipomas: Still Navigating the Labyrinth?

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Spinal Dysraphic Malformations

Part of the book series: Advances and Technical Standards in Neurosurgery ((NEUROSURGERY,volume 47))

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Abstract

This review summarises the classification, anatomy and embryogenesis of complex spinal cord lipomas and describes in some detail the technique of total lipoma resection and radical reconstruction of the affected neural placode. Its specific mission is to tackle two main issues surrounding the management of complex dysraphic lipomas: whether total resection confers better long-term benefits than partial resection and whether total resection does better than conservative treatment, i.e. no surgery, for asymptomatic lipomas. Accordingly, the 24-year progression-free survival data of the senior author and colleagues’ series of over 300 cases of total resection are compared with historical data from multiple series (including our own) of partial resection, and total resection data specifically for asymptomatic lesions are compared with the two known series of non-surgical treatment of equivalent patients. These comparisons so far amply support the author’s recommendation of total resection for most complex lipomas, with or without symptoms. The notable exception is the asymptomatic chaotic lipoma, whose peculiar anatomical relationship with the neural tissue defies even our aggressive surgical approach, and consequently projects worse results (admittedly of small number of cases) than for the other two lipoma subtypes of dorsal and transitional lesions. Prophylactic resection of asymptomatic chaotic lipomas is therefore not currently endorsed. We have also recently found that some dorsal lipomas with clear outline of the conus on preoperative imaging had a significantly better long-term prognosis of preserving neurourological functions without surgery. Whether this subset of lipomas should be managed conservatively until symptoms arise is now an open question awaiting a longer follow-up of a larger cohort of such patients.

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Notes

  1. 1.

    The term neural placode in lipoma is borrowed from the main neural core of an open neural tube defect or ONTD, to emphasise its similar “neural” nature once the lipoma is removed. The synonymous usage of the term in lipoma and ONTD is logical if one compares the embryogenesis of the two entities (see below): the “placode” in each case represents the original embryonic neural plate blighted in its final completing stage: having been invaded by paraxial mesenchyme in lipoma, and thwarted in its midline dorsal fusion in ONTD.

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Conflict of Interest Statement

The author states that he has no conflicts of interests associated with the making of this manuscript.

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Authors and Affiliations

  1. Department of Paediatric Neurosurgery, University of California, Davis, USA

    Dachling Pang

  2. Great Ormond Street Hospital for Children, NHS Trust, London, UK

    Dachling Pang & Dominic N. P. Thompson

  3. Department of Developmental Neuroscience, University College London-Institute of Child Health, London, UK

    Dominic N. P. Thompson

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  1. Dachling Pang
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Editors and Affiliations

  1. NHS Trust, Great Ormond Street Hospital, LONDON, UK

    Dachling Pang

  2. Center for Rare Cancers, National Cancer Center, Goyang, Korea (Republic of)

    Kyu-Chang Wang

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Pang, D., Thompson, D.N.P. (2023). The Current Status of the Surgical Management of Complex Spinal Cord Lipomas: Still Navigating the Labyrinth?. In: Pang, D., Wang, KC. (eds) Spinal Dysraphic Malformations. Advances and Technical Standards in Neurosurgery, vol 47. Springer, Cham. https://doi.org/10.1007/978-3-031-34981-2_6

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