You are doing a Terry Myles tour of duty in SE Asia and see a 5 month old girl in clinic with the pictured abnormality.

Lipomyelomengocele

Subcutaneous lipomas most common(60-90%)
angioma(20%)
hairy patch, dermal sinus tract, appendage (pictured)

If symptomatic:

• Surgical untethering with SSEP and EMG (+sphincters)

If asymptomatic:

• may follow clinically and with urodynamics. Surgery has high complication rate. Even after prophylactic surgery 20-40% will develop delayed symptoms

Goals: Prevent progression of symptoms.
Outcome/Expecations:

• 20% wound problems: infection, csf leak, dehiscence
• 5% neurologic deterioration
• 20% delayed neurologic deteriroation requiring repeat detethering