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Lumbosacral lipoma in childhood, how strong is the evidence base? A systematic review

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Abstract

Objective

Conus region lumbosacral lipomas (LSLs) are highly heterogeneous in their morphology, clinical presentation, and outcome, with an incompletely understood natural history and often treacherous surgical anatomy. This systematic review aims to critically evaluate and assess the strength of the current LSL evidence base to guide management strategies.

Methods

According to a systematic review following PRISMA guidelines, a search was conducted using the key term “lumbosacral lipoma” across MEDLINE (OVID), Embase, Cochrane Library, and PubMed databases from January 1951 to April 2021. All studies containing ten or more paediatric conus lipomas were included. Data heterogeneity and bias were assessed.

Results

A total of 13 studies were included, containing 913 LSLs (predominantly transitional type—58.5%). Two-thirds (67.5%) of all patients (treated and non-treated) remained clinically stable and 17.6% deteriorated. Neuropathic bladder was present in 8.6% at final follow-up. Of patients managed surgically, near-total resection vs. subtotal resection deterioration-free survival rates were 77.2–98.4% and 10–67% respectively. 4.5% (0.0–27.3%) required re-do untethering surgery. Outcomes varied according to lipoma type. Most publications contained heterogeneous populations and used variable terminology. There was a lack of consistency in reported outcomes.

Conclusion

Amongst published series, there is wide variability in patient factors such as lipoma type, patient age, and methods of (particularly urological) assessment. Currently, there is insufficient evidence base upon which to make clear recommendations for the management of children with LSL. There is an imperative for neurosurgeons, neuroradiologists, and urologists to collaborate to better standardise the terminology, assessment tools, and surgical interventions for this challenging group of conditions.

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Authors and Affiliations

  1. Department of Paediatric Neurosurgery, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, WC1N 3JH, UK

    Duranka Perera, Claudia L. Craven & Dominic Thompson

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  1. Duranka Perera
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  2. Claudia L. Craven
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  3. Dominic Thompson
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Contributions

DP, CC and DT all contributed significantly towards the writing of the main manuscript text. DP and CC prepared Figs. 1–6 and Tables 1–4, DT reviewed them prior to submission and final inclusion. All authors reviewed the final manuscript.

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Correspondence to Dominic Thompson.

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Perera, D., Craven, C.L. & Thompson, D. Lumbosacral lipoma in childhood, how strong is the evidence base? A systematic review. Childs Nerv Syst 40, 715–728 (2024). https://doi.org/10.1007/s00381-023-06203-9

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