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Thread: Spinal cord lipoma

  1. #1

    Question Spinal cord lipoma

    I need help in advise and locating a top-notch neurosurgeon who is familar with operating using kavitron in the brain/spinal cord area.My son's lipoma (born with) has grown and causing more nerve damage...lower extremeties now, bladder, etc. He saw a doc yesterday who pretty much said, "no surgery, you'll be paralyzed, surgery, you'll be paralyzed"...We live in Rochester, NY area, but will travel to "whereever" to find the right doc.

    We need help in locating a neurosurgeon tops in his field in operating on this kind of tumor....

    Forever greatful!

    Carol (Matt's mom)

  2. #2
    Teresa, welcome to care cure from another "Okie"...Good luck with finding a doctor and any procedure they think you need...hope the pain doesn't get any worse...judy

  3. #3
    Quote Originally Posted by wunerful111 View Post
    I need help in advise and locating a top-notch neurosurgeon who is familar with operating using kavitron in the brain/spinal cord area.My son's lipoma (born with) has grown and causing more nerve damage...lower extremeties now, bladder, etc. He saw a doc yesterday who pretty much said, "no surgery, you'll be paralyzed, surgery, you'll be paralyzed"...We live in Rochester, NY area, but will travel to "whereever" to find the right doc.

    We need help in locating a neurosurgeon tops in his field in operating on this kind of tumor....

    Forever greatful!

    Carol (Matt's mom)

    Carol, the instrument is a Cavitron ultrasonic aspirator. The man who initiated its use for spinal tumors was Fred Epstein at NYU but he died recently. Because lipomas are rare, about 1% of spinal cord tumors, few neurosurgeons have had substantial experience with them. However, they are often associated with spina bifida. I did a literature search to find all the surgeons who have published significant series of cases of spinal cord lipomas. The largest recent series of 250 cases that I was able to find was published by Pang, et al. {Pang, 2009 #2} from the University of California (Oakland). The spinal cord is often tethered to the lipoma {Samuels, 2009 #2}. There is a new instrument available to removing tumors and untethering the spinal cord {Browd, 2009 #3}. I am attaching the papers so that you can look up the names of the authors, their institutions, and their addresses.

    Wise.

    References

    1. Pang D, Zovickian J and Oviedo A (2009). Long-term outcome of total and near-total resection of spinal cord lipomas and radical reconstruction of the neural placode: part I-surgical technique. Neurosurgery 65: 511-28; discussion 528-9. Regional Center of Pediatric Neurosurgery, University of California, Davis, Kaiser Foundation Hospitals of Northern California, Oakland, California, USA. PangTV@aol.com. OBJECTIVE: Partial resection of complex spinal cord lipomas is associated with a high rate of symptomatic recurrence caused by retethering, presumably promoted by a tight content-container relationship between the spinal cord and the dural sac, and incomplete detachment of the terminal neural placode from residual lipoma. Since 1991, we have performed more than 250 total/near-total resections of complex lipomas with radical reconstruction of the neural placodes. Sixteen years of follow-up have proven the long-term benefits of this technique. Part I of this series introduces our technique of total resection and reports the immediate surgical results. Part II will analyze the long-term outcomes of both total and partial resection and identify the factors affecting outcome. METHODS: From 1991 to 2006, 238 patients (age range, 2 months-72 years) with dorsal, transitional, and chaotic lipomas underwent total or near-total lipoma resection and radical placode reconstruction. Eighty-four percent of the patients were children younger than 18 years and 16% were adults. The technique consisted of wide bony exposure, complete unhinging of the lateral adhesions of the lipoma-placode assembly from the inner dura, untethering of the terminal conus, radical resection of the fat off the neural plate along a white fibrous plane at the cord-lipoma interface, meticulous pia-to-pia neurulation of the supple neural placode with microsutures, and expansile duraplasty with a bovine pericardial graft. Elaborate electrophysiological monitoring was used. RESULTS: Three postoperative observations concern us. The first is that of the 238 patients, 138 (58%) had no residual fat on postoperative magnetic resonance imaging; 81 patients (36%) had less than 20 mm3 of residual fat, the majority of which were small bits enclosed by neurulation; and 19 patients (8%), mainly of the chaotic lipoma group, had more than 20 mm of fat. There are no significant differences in the amount of residual fat among lipoma types, but redo lipomas are more likely than virgin (previously unoperated on) lipomas to have residual fat by a factor of 2 (P = 0.0214). The second concern is that the state of the reconstructed placode is objectively measured by the cord-sac ratio, obtained by dividing the sagittal diameter of the reconstructed neural tube by the sagittal diameter of the thecal sac. A total of 162 patients (68%) had cord-sac ratios less than 30% (low), 61 (25.6%) had ratios between 30% and 50% (medium), and only 15 (6.3%) had high ratios of more than 50%. Seventy-four percent of patients with virgin lipomas had low cord-sac ratios compared with 56.3% in the redo lipoma patients. The overall distribution of cord-sac ratio is significantly different between redo and virgin lipomas (P = 0.00376) but not among lipoma types. Finally, the incidence of combined neurological and urological complications was 4.2%. The combined cerebrospinal fluid leak and wound infection/dehiscence incidence was 2.5%. Both sets of surgical morbidity compared favorably with the published rates reported for partial resection. CONCLUSION: Total/near-total resection of spinal cord lipomas and complete reconstruction of the neural placode can be achieved with low surgical morbidity and a high yield of agreeable postoperative cord-sac relationship. Some large rambling transitional lipomas and most chaotic lipomas are the most difficult lesions to resect and tend to have less favorable results on postresection magnetic resonance imaging.

    2. Samuels R, McGirt MJ, Attenello FJ, Garces Ambrossi GL, Singh N, Solakoglu C, Weingart JD, Carson BS and Jallo GI (2009). Incidence of symptomatic retethering after surgical management of pediatric tethered cord syndrome with or without duraplasty. Childs Nerv Syst 25: 1085-9. Department of Neurosurgery, Johns Hopkins School of Medicine, 600 N Wolfe Street, Meyer 8-161, Baltimore, MD 21287, USA. BACKGROUND: Cord retethering and other postoperative complications can occur after the surgical untethering of a first-time symptomatic tethered cord. It is unclear if using duraplasty vs. primary dural closure in the initial operation is associated with decreased incidence of either immediate postoperative complications or subsequent symptomatic retethering. It is also unclear if different etiologies are associated with different outcomes after each method of closure. We reviewed our pediatric experience in first-time surgical untethering of symptomatic tethered cord syndrome (TCS) to identify the incidence of postoperative complications and symptomatic retethering after duraplasty vs. primary closure. MATERIALS AND METHODS: We retrospectively reviewed 110 consecutive pediatric (<18 years old) cases of first-time symptomatic spinal cord untethering at our institution over a 10-year period. Incidence of postoperative complications and symptomatic retethering were compared in cases with duraplasty vs. primary dural closure use. RESULTS: Mean age was 5.7 +/- 4.8 years old. "Complex" etiologies included lipomyelomeningocele or prior lipomyelomeningocele repair in 22 (20%) patients, prior myelomeningocele repair in 35 (32%), and concurrent lumbosacral lipoma in 18 (16%). "Noncomplex etiologies" included fatty filum in 26 (24%) and split cord malformation in five (4%). Seventy-five (68%) cases underwent primary dural closure vs. 35 (32%) with duraplasty. Twenty-nine (26%) patients experienced symptomatic retethering at a median [interquartile range (IQR)] of 30.5 [20.75-41.75] months postoperatively. There was no difference in incidence of postoperative cerebrospinal fluid leak, surgical site infection, or median [IQR] length of stay in patients receiving primary dural closure [4 (5%), 7 (9%), and 5 (4-6) days, respectively] vs. duraplasty [3 (9%), 3 (9%), and 6 [5-8] days, respectively], p > 0.05. Complex etiologies were more likely to retether than noncomplex etiologies after primary closure (33.6% vs. 6.6%, p = 0.05) but not after duraplasty (13.7% vs. 5.4%, p = 0.33). Duraplasty graft type (polytetrafluoroethylene vs. bovine pericardium) was not associated with pseudomeningocele or retethering. CONCLUSION: In our experience, the increased rate of symptomatic retethering observed with complex pediatric TCS (pTCS) etiologies after primary dural closures was not observed when duraplasty was instituted. Expansile duraplasty may be valuable specifically in the management of patient subgroups with complex pTCS etiologies.

    3. Browd SR, Zauberman J, Karandikar M, Ojemann JG, Avellino AM and Ellenbogen RG (2009). A new fiber-mediated carbon dioxide laser facilitates pediatric spinal cord detethering. Technical note. J Neurosurg Pediatr 4: 280-4. Department of Pediatric Neurological Surgery, Seattle Children's Hospital and Regional Medical Center, Seattle, Washington 98105, USA. OBJECT: The authors report their experience with a novel flexible fiber capable of transmitting CO(2) laser energy during spinal cord tumor resection and detethering. METHODS: A fiber optic system capable of transmitting CO(2) laser energy was used in the detethering of the spinal cord in 3 cases. The first case involved a 9-year-old girl with a terminal lipoma. The second case was an 11-month-old boy with a thoracic intramedullary dermoid and dermal sinus tract. The third case involved a 13-year-old girl suffering from a tethered spinal cord subsequent to a previously repaired myelomeningocele. RESULTS: In all 3 cases, the new fiber CO(2) laser technology allowed the surgeon to perform microsurgical dissection while sparing adjacent neurovascular structures without time-consuming setup. The system was easy to implement, more ergonomic than previous technologies, and safe. The CO(2) laser provided the ability to cut and coagulate while sparing adjacent tissue because of minimal energy dispersion and ease of use, without the articulating arms involved in the prior generation of lasers. CONCLUSIONS: Using a flexible fiber to conduct CO(2) laser energy allows accurate microneurosurgical dissection and renders this instrument a high-precision and ergonomic surgical tool in the setting of spinal cord detethering.

  4. #4
    Senior Member JimD's Avatar
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    Quote Originally Posted by wunerful111 View Post
    I need help in advise and locating a top-notch neurosurgeon who is familar with operating using kavitron in the brain/spinal cord area.My son's lipoma (born with) has grown and causing more nerve damage...lower extremeties now, bladder, etc. He saw a doc yesterday who pretty much said, "no surgery, you'll be paralyzed, surgery, you'll be paralyzed"...We live in Rochester, NY area, but will travel to "whereever" to find the right doc.


    For what it's worth, I had detethering surgery done at Montefiore Medical Center in the Bronx. The surgeon was Dr. James Goodrich, who came very highly recommended and who I in turn recommend. Some information in the link:

    http://www.montekids.org/services/ne...ians/goodrich/


    Good luck, whatever you decide to do!

  5. #5
    Fred Epstein protege is Dr. George Jallo at John Hopkins. He is the leading Pediatric Neurosurgeon and has experience with Tumors. I know many people who he has operated on and they are walking and living normal lives. Also I would invite you to this group and post there as well as these folks are all Spinal Cord Tumor survivors and have a wealth of knowledge.

    WWW.spinalcordtumor.org


    BTW- I had a tumor in my Cervical area inside my cord. I walk and function normally but do have sensory loss. Small price to pay for being able to walk.

  6. #6

    spinal cord surgery

    For any who need a top surgeon in this area it is Dr. Leslie Sutton at the Children's Hospital in Philadelphia, PA. He is one of the few and leading neurosurgeons in this area. He is right now operating on my son for his tethered spinal cord.

  7. #7

    John Hopkins Pediatric Neurosurgeon

    The previous poster mentioned Fred Epstein and Dr George Jallo was trained by him and works at John Hopkins. Here is his contact information:

    http://www.hopkinsmedicine.org/neuro...B/George_Jallo

    Good luck.

    You can also find help on the Spinal Cord Tumor Association website:

    www.spinalcordtumor.org

    Steve

  8. #8

    Would like Input

    I have a large lump on my back above my spinal column. It has been there for a long time, almost 20 years in fact. At least that is when it was first brought to my attention by a chiropractor. He immediately called it a Fatty Tumor LIpoma and said: "Dont worry about it unless it causes you pain".
    -----
    I have had it for so long that I rarely if ever pay it any attention. But recently, I have noticed tingling in my left arm and that area in my back where the lipoma is located has felt uncomfortable. The uncomfortableness I have experienced on and off through the years when I sit too long, work too much, get too stressed .. etc.
    ------
    It is obvious that the mass on my back is pressing against something. I am just curious about having it removed. It is a noticeable lump on my back. It has been there for almost 20 years if not longer. It appears to be a little larger now.
    ------
    It may or may not be associated with the tingling sensation in my left arm. I am not sure at this point. The tingling could be due to a pinched nerve in my neck which I usually go to a chiropractor for but have not been doing my regular visits for a year now because of the economy .. job loss .. etc ..
    ------
    I am working now and am going to the chiropractor again. However, I am just wondering if that lump in my back is starting to cause additional problems and if so ..
    -------
    WOULD SURGERY BE RISKY ..

  9. #9

    i have same case please help

    Dear Responsible Person,
    For God sake please try to advice me regarding my critical case.
    Am 28 years male from lebanon. Last year i lift some heavy weight
    which cause me a low back unbelievable pain.
    After MRI done it shows a tumor in spinal cord at T10-T11. I was operated
    to surgery by neurosurgeon in which he make me laminectomy. You are lucky
    that your tumor is not cancer he say and it have very very slow volume increase
    and he told me that even if volume will increase he give it enough space and i am
    safe. Coming back to my normal life doctor say. But impossible.Pain still there.
    I feel like some one is compressing my back specially when i seat for more that 1 hr.
    My left foot down from the knee to the finger toes is coming tingling and i fell it some
    time like concrete casted like one block. i visit back my doctor. he say this pain is back
    pain not from tumor(since i am scoliosis) and you need phisiotherapy.I make around 40
    sessions of physiotherapy but meaningless. Driving my car become very difficult specially on
    bad road, i feel like my back have no more shock absorption.
    To avoid pain i start seating in oblique way but now i start realize a neck pain because of that.
    I visit other doctors from american hospital they tell me that all this pain is coming from the tumor.
    It is very dangerous to remove it since i have chance 10 over 100 to get paralysed. and now after
    i did laminectomy the chance is 50 over 100 to get paralyzed.
    When i am standing i have no pain.
    Please advice what i should do! I feel down down down. Even my fiance and parents give me good
    support but i fell down.
    Please help tell me what is next step to be done. Is there any scientific way to specify if pain is coming from tumor or
    back pain as my first doctor say(i visited orthopedic doctor he say that scoliosis give no pain).Is the pain come from
    disk decompression, because if i take risk to do the surgery i should be sure that this risk will be positive if surgery succes.
    There is and technology which make this operation less difficult like Radiotherapy r cyberknife(posted on youtube).

    Thanks a lot.
    email me on elieazar82@hotmail.com
    i will update you with the new docotr advice in 2011

  10. #10
    I don't understand. The surgery you had, was it just for a biopsy? Did they not attempt to remove the tumor, and why?

    To the original poster if you actually still follow this thread, I had my surgery with Dr. Jallo and would definitely recommend him. He is exactly what you are looking for.
    C3/4 Incomplete. Ependymoma tumor, syrinx from C to T.

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