Nazar Sakhidovich Annanepesov neurosurgeon of the Department of Neurology and Neurosurgery named after Yu. S. Martynov, Peoples’ Friendship University of Russia (8, Miklukho-Maklaya str., Moscow, 117198), Morozovskaya Children’s City Clinical Hospital (Moscow, Russia), e-mail: annanepesov93@gmail.com, ORCID: 0000-0002-9667-3642
Pavel Vladimirovich Lobankin Neurosurgeon, Morozovskaya Hospital of the Moscow Department of Health, 1/9, 4th Dobryninsky Lane, Moscow, 119037, e-mail: pashunia@gmail.com, ORCID: 0009‑0002‑4317-904X
Viktor Nikolaevich Umerenkov Head of the Department of Neurosurgery Morozovskaya Hospital of the Moscow Department of Health, 1/9, 4th Dobryninsky Lane, Moscow, 119037, e-mail: wicnic@yandex.ru, ORCID: 0000‑0001‑7821‑0997
Gennadiy E. Chmutin head of the Department of Neurology and Neurosurgery named after Yu. S. Martynov, Peoples’ Friendship University of Russia (8, Miklukho-Maklaya str., Moscow, 117198), Morozovskaya Children’s City Clinical Hospital (Moscow, Russia), e-mail: neuro2009@yandex.ru, ORCID: https://orcid.org/0000-0002-3323-508X
Egor Gennadievich Chmutin neurosurgeon, assistant professor of the Department of Neurology and Neurosurgery named after Yu. S. Martynov, FSAEI HE Peoples’ Friendship University of Russia, 8, Miklukho-Maklaya str., Moscow, 117198, e-mail: echmutin@yahoo.com, ORCID id: https://orcid.org/0000-0003-0341-5693
Aleksandra Andreevna Kuznetsova neurologist, Morozov Children’s City Clinical Hospital of the Moscow Healthcare Department, 1/9, 4th Dobryninsky lane, Moscow, 119037, e-mail: nevrolog.kuznetsova@yandex.ru, ORCID: 0000-0002-0344-9765
Bupe M. Mwela pediatrician of the Department of Pediatrics, FSAEI HE Peoples’ Friendship University of Russia (8, Miklukho-Maklaya str., Moscow, 117198), Livingstone Teaching Hospital (Livingstone, Zambia), e-mail: mwelamd@gmail.com, ORCID: 0000-0003-1426-8334
Musa Gerald neurosurgeon, assistant professor of the Department of Neurology and Neurosurgery named after Yu. S. Martynov, Peoples’ Friendship University of Russia (8, Miklukho-Maklaya str., Moscow, 117198), Livingstone Teaching Hospital (Livingstone, Zambia), e-mail: gerryMD@outlook.com, ORCID: https://orcid.org/0000-0001-8710-8652
Background: Surgical management of lumbosacral lipomas typically involves untethering of the cord and lipoma resection, but closure of the dura can be achieved by a primary watertight suture or by an expansile duraplasty. The optimal closure strategy remains debated. We retrospectively compared outcomes of primary dural closure versus expansile duraplasty in pediatric lumbosacral lipoma resection, and autologous aponeurotic grafts versus synthetic dural substitutes within the duraplasty group. Methods: We reviewed 52 children and adolescents who underwent surgical treatment of lumbosacral lipomas. Primary dural closure was performed in 34 patients, and expansile duraplasty (using a dural graft) in 18 i.e., aponeurotic graft (n=13) and a synthetic dural substitute (n=5). Postoperative neurological function, re-tethering events, urodynamic changes, wound complications, reoperations, and final ambulatory status (McCormick scale) were recorded over a median follow-up of 3.5 years. Outcomes were compared between closure technique groups and between graft types. Results: New or worsened postoperative neurological deficits occurred in 5/34 (14.7 %) with primary closure versus 1/18 (5.6 %) with expansile duraplasty (p=0.26). Symptomatic retethering (clinical relapse with MRI confirmation) required repeat surgery in 7/34 (20.6 %) of primary closure cases versus 1/18 (5.6 %) in the duraplasty group (p=0.09). Wound complications (superficial dehiscence or CSF leak) were low in both groups (8.8 % vs 11.1 %, p=0.79), and all were managed conservatively (no reoperation). Urodynamic improvement occurred in 11/34 (32.4 %) of primary closure patients versus 9/18 (50 %) of duraplasty patients (p=0.18). Repeat untethering surgery was needed in 4/34 (11.8 %) of primary closure cases and 1/18 (5.6 %) of duraplasty cases (p=0.41). At final follow-up, 21/34 (61.8 %) of primary closure patients versus 14/18 (77.8 %) of duraplasty patients had fully independent ambulation (McCormick I), and fewer duraplasty patients had severe motor impairment (McCormick III–IV: 5/34 [14.7 %] vs 1/18 [5.6 %]). Within the duraplasty group, postoperative neurological worsening occurred in 1/13 (7.7 %) of those with autologous graft versus 0/5 with synthetic graft (p=0.52). One patient (7.7 %) with autologous graft had retethering requiring surgery; none did in the synthetic graft subgroup (p=0.55). Urodynamic improvement rates were comparable (53.8 % vs 40 %, p=0.63), as were wound complication (15.4 % vs 20 %, p=0.81) and reoperation rates (7.7 % vs 0, p=0.52). Functional independence (McCormick I) was similar (76.9 % vs 80 %). Conclusions: Expansile duraplasty trended toward better neurological and re-tethering outcomes than primary dural closure, likely by providing more intradural space around the neural placode. Wound complication and CSF leak rates were low with either technique when meticulous multilayer closure was used. Bladder function tended to improve more after duraplasty, suggesting better decompression. These results support the use of expansile duraplasty (with either graft type) to potentially reduce tethering recurrence without increasing complications in children undergoing lipoma resection.
