Surgical treatment of lipoma type tethered cord syndrome in children

Objective To investigate the surgical treatment and its efficacy of lipoma type tethered cord syndrome(TCS)in children. Methods The clinical data of 245 children with lipoma type TCS admitted to the Department of Neurosurgery, Chinese PLA General Hospital from January 2008 to January 2015 were analyzed retrospectively. According to the imaging findings, the 245 children were divided into four types: dorsal type, caudal type, chaotic type, lipo-myelomeningocele type. All the children were treated with microsurgery. Spina bifida neurological scale(SBNS)was used to evaluate the efficacy of surgical treatment. The follow-up time ranged from 6 to 60 months. Results The total effective rate of 245 children with lipoma type TCS after procedure was 76.0%. Among all types of TCS, the effect of dorsal type was best, and then followed by caudal type, lipo-myelomeningocele type, and chaotic type. The effect of total resection(near total resection)group was better than the subtotal resection group. Conclusions Once the lipoma type TCS is diagnosed, early surgery can prevent or reduce the defecation dysfunction and both lower extremity dysfunction after the growth and development of children. Surgery should strive to total or subtotal resection of lipomas in order to complete release of the spinal cord and cauda equine. The main factors for influencing the operative effect and prognosis were the types of lipomas, timing of operation, preoperative symptoms, complete neurolysis or not, and having retethering or not. Key words: Tethered cord syndrome; Classification; Microsurgery; Prognosis