第38回日本小児神経外科学会
The 38th Annual Meeting of the Japanese Society for Pediatric Neurosurgery

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第2日目、6月5日(土)A 会場(3階 メインホール)11:20〜11:55

特別講演 3: Alain Pierre-Kahn

座長: 大井静雄

SL3

Spinal Lipomas of the Conus. Is prophylactic surgery a myth or a reality ? Ethical considerations

Alain Pierre-Kahn Paris

Former, Professor of Necker Enfants-Malades Hospital

Background and Purpose :

The disappointing results we observed after early surgery on spinal lipomas of the conus (SLCs) pushed us to set up a protocol of conservative management. We give the 10 year results of this protocol and discuss the optimal management of these lesions.

Methods :

From 1994 to 2007, all asymptomatic patients with a SLC entered a protocol of conservative management to determine the incidence and timing of neurological deterioration. These results were compared to those of our historical series of patients who underwent early surgery.

Results :

A cohort of 106 asymptomatic children (41 males, 65 females) with SLC were treated conservatively. During a mean follow-up of 6.5 years (range 18 months, 17 years), 33 patients developed symptoms (31%) requiring surgery. At 15 years, the actuarial risk of deterioration determined with the Kaplan Meier method was 34% for the conservatively treated patients and 46% for the surgically treated patients (p=0.19). After surgery, deficits cleared totally or sub-totally in 57% of the patients. At 10 years, the probability to be asymptomatic or pauci-symptomatic (according to our functional score) was 91% after conservative treatment and 70% after early and routine surgery (p=0.26).

Conclusions:

At 15 years, the risk of neurological degradation is 34%. This risk is not minimized by early surgery. Functional results seem better after conservative treatment than after early surgery. These results raise indubitable ethical problems.

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