Information de reference pour ce titreAccession Number: | 00006123-200404000-00027.
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Author: | Kulkarni, Abhaya V. M.D., Ph.D.; Pierre-Kahn, Alain M.D.; Zerah, Michel M.D.
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Institution: | Division of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada Service de Neurochirurgie Pediatrique, Groupe Hospitalier Necker-Enfants Malades, Paris, France Service de Neurochirurgie Pediatrique, Groupe Hospitalier Necker-Enfants Malades, Paris, France
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Title: | |
Source: | Neurosurgery. 54(4):868-875, April 2004.
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Abstract: | OBJECTIVE: The natural history of spinal lipomas of the conus (SLCs) has not been well studied. Because of disappointing long-term results with early surgical treatment of asymptomatic children with SLCs, we have followed a protocol of conservative management for these patients. The results are presented in this report.
METHODS: Since 1994, all asymptomatic children with SLCs who were examined at Necker-Enfants Malades Hospital were subject to a protocol of conservative management. The records for those patients were reviewed, to determine the incidence and timing of neurological deterioration. The findings were compared with those for a previously reported historical cohort of asymptomatic patients who underwent early surgery at our institution.
RESULTS: Fifty-three asymptomatic children (35 girls and 18 boys) with SLCs were monitored, with conservative management. During a mean follow-up period of 4.4 years (range, 12 mo to 9 yr), 13 patients (25%) exhibited neurological deterioration. At 9 years, the actuarial risks of deterioration, as determined with the Kaplan-Meier method, were 33% for the conservatively treated patients and 46% for the surgically treated patients. With a Cox proportional-hazards model, there was no significant difference in the risks of neurological deterioration for patients who were treated conservatively and those who underwent early surgery.
CONCLUSION: The incidences and patterns of neurological deterioration seemed to be very similar, regardless of whether early surgery was performed. These results suggest that conservative treatment of asymptomatic patients is a reasonable option. A more definitive randomized study will be required to clarify the relative efficacy of early surgery for SLCs among asymptomatic patients.
Copyright (C) by the Congress of Neurological Surgeons
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Author Keywords: | Lipoma; Natural history; Pediatric; Spinal dysraphism; Surgery.
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2. Cochrane DD, Finley C, Kestle J, Steinbok P: The patterns of late deterioration in patients with transitional lipomyelomeningocele. Eur J Pediatr Surg 10 [Suppl 1]: 13-17, 2000.
3. Dorward N, Scatliff J, Hayward R: Congenital lumbosacral lipomas: Pitfalls in analysing the results of prophylactic surgery. Childs Nerv Syst 18: 326-332, 2002.
4. Pierre-Kahn A, Zerah M, Renier D, Cinalli G, Sainte-Rose C, Lellouch-Tubiana A, Brunelle F, Le Merrer M, Giudicelli Y, Pichon J, Kleinknecht B, Nataf F: Congenital lumbosacral lipomas. Childs Nerv Syst 13: 298-334, 1997.
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Language: | English.
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Document Type: | CLINICAL STUDIES.
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Journal Subset: | Clinical Medicine. Life & Biomedical Sciences.
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ISSN: | 0148-396X
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NLM Journal Code: | nzl, 7802914
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DOI Number: | https://dx.doi.org/10.1227/01.NE...- ouverture dans une nouvelle fenêtre
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