Lumbosacral lipoma detethering

Operated by Jun Kyu hwang

A low-lying conus medullaris is observed, and the lower part of the cord is connected to the subqutaenous fat. The dura mater is developed in a state of being spread out internally.

The incision is performed by predicting the dural opening site at the tail-like stigma location. Unlike normal subqutaneous fat tissue, lumbosacral lipoma is whitish and has a different appearance. This is confirmed and the area with the dural opening is approached while reducing the abnormal fat volume. While removing the fat margin and finding the border with the dura mater, CSF is identified. From that point on, the area is gradually removed, especially to avoid damaging the surrounding nerve roots. By repeating fat removal and nerve stimulation, the fat volume is reduced as much as possible, and all adhesions are separated. The goal is near total removal of the border attached to the spinal cord, but a small amount is left to avoid damaging the cord.

Check for open dura margins and perform duraplasty using surgical, tachose, glue, etc. to prevent leakage. The outer surface is then closed layer by layer.