A success of lipomyelomeningocele resection with intraoperative neurophysiological monitoring (IONM) guidance in a 10-year-old child: A case report

Introduction: Lipomyelomeningocele is one of closed spinal dysraphism, inherently associated with tethered cord. Its prevalence ranges between 0.3 and 0.6 per 10.000 live births. Deterioration of bladder and bowel function often manifests before the motor and sensory function. Intraoperative neurophysiological monitoring (IONM) is often used in lipomyelomeningocele surgery to facilitate safe resection of lipomatous components and detethering of the spinal cord due to the absence of a clear boundary between the lipoma and neural placode.This case highlights the critical role of adequate IONM to reduce the complications of lipomyelomeningocele resection surgery. Case Presentation: Here we present a 10-year-old boy with a lump over the back since birth, progressively increased in size, and with a history of urinary and faecal incontinence since one year before admission. There was also hypoesthesia on lumbar 2 spinal cord level. Physical examination of the lumbosacral region revealed a single lump measured about 4.5 x 1.9 x 3.2 cm in size, soft consistency, and immobile. Magnetic resonance imaging of the lumbosacral region revealed a lipomyelomeningocele with tethered cord protruded into the anatomical defect from sacral vertebrae S1-S4. Surgery was indicated because of the neurological symptoms and it was safely performed with the assistance of IONM. There were no postoperative complications after surgery and there was an improvement in the patients’ neurological symptoms. Conclusion: IONM in spinal surgery has been proven useful to reduce the postoperative neurological complication by providing identification of neural structures topographically and functionally, therefore, giving a warning alarm during surgery, which can be immediately responded by the surgeons.