Classification and surgical treatment of complex spinal lipoma in children

Objective To discuss the classification and surgical treatment strategies of complex spinal lipoma in children. Methods A total of 68 children with complex spinal lipoma were selected for treatment at Beijing Tsinghua Changgung Hospital, Affiliated Hospital of Tsinghua University from January 2015 to January 2023. They were divided into dorsal type (n = 42), transitional type (n = 15) and chaotic type (n = 11) based on XIU - SUN classification. All patients underwent microsurgical treatment under neurophysiological monitoring. The early (within one month after surgery) and long-term (over one year after surgery) efficacy and safety of all patients were evaluated. Results Early efficacy: according to the Kirollos grading method for intraoperative decompression, 61 cases (89.71%) reached level Ⅰ , 5 cases (7.35%) reached level Ⅱ , and 2 cases (2.94%) reached level Ⅲ ; according to the degree of resection, complete resection was achieved in 7 cases (10.29%), subtotal resection in 16 cases (23.53%), and partial resection in 45 cases (66.18%). Long-term efficacy: all patients were followed up for (5.00 ± 0.20) years. According to the McCormick spinal cord injury grading system, there was no statistically significant difference in the preoperative and postoperative neurological scores of the dorsal type (χ2 = 0.364, P = 0.549), transitional type (χ2 = 0.125, P = 1.000) and chaotic type (χ2 = 1.500, P = 0.219). MRI examination revealed recurrence of lipoma in 6 cases (8.82%). The postoperative symptoms improved to different degrees, and the progression free survivial rate was 91.18% (62/68). Postoperative complications: 25 cases (36.76%) of postoperative complications were observed, including urinary and fecal dysfunction in 13 cases (19.12%), decreased muscle strength in 9 cases (13.24%), cerebrospinal fluid leakage in 3 cases (4.41%), central nervous system infection leading to acute hydrocephalus in 2 cases (2.94%), with 2 cases presenting with both decreased muscle strength and urinary and fecal dysfunction. Conclusions XIU - SUN classification has a guiding role in surgical strategy. In cases of dorsal type and most of transitional types, a subtotal or complete resection can be chosen. For chaotic type and medullary type, a reduction - based approach is recommended. All types of spinal lipoma should undergo detachment release.