Tethered Cord Syndrome Combined with Lipomyelomeningocele
Introduction Lipomyelomeningocele is a rare malformation, with harmless beginning and often poor outcomes, resulting in the tethered cord effect.
Aim To share our operative experience, to summarize known-to-date solutions, and to analyze the treatment of this pathology for the past 10 years.
Material and Methods Six patients were operated whose age ranged from 2 to 9 years; male to female ratio was 1:1. Two of the children were reoperated 5 and 7 years after the first intervention—the reason was development of a tethering effect in both cases. The aim of the treatment is to release the caudal parts of the medulla from the dura and to completely resect the lipomatous tissue as much as possible. We use microneurosurgical technique and neuromonitoring. The residual tumor mass cannot always be integrated freely in the dural sac; in these cases, we performed one-level laminectomy to the cranial and we expand the dural sac with lyophilized pericardium, and we seal the line of suturing with fibrin glue. In some of the cases, we use a single strips of pericardium fixed to the tops of the malformated vertebral arches to achieve modelling of the vertebral canal.
Results Postoperatively, no additional neurological deterioration, no liquorrhea, and no mortality were observed.
Conclusion Tethered cord syndrome is a condition characterized by the development of different disorders in the distal section of the structures of the spine. The combination of progressive dysfunction, paraparesis inferior, incontinence/retention, deformities, atrophy, spine pain syndrome, and the MRI and CT scan results is very important for the proper diagnosis. The early diagnosis and the operative treatment may improve the outcome and the prognosis for the patient.
Keywords lipomyelomeningocele; tethered cord effect; operative technique; results