Background: The management of asymptomatic lumbosacral lipomas remains controversial, with studies reporting both prophylactic surgery and conservative management. This review compares conservative and surgical treatment approaches for asymptomatic lumbosacral lipomas in children, analyzing outcomes, complications and secondary treatment. Methods: A systematic literature review was conducted using PubMed, Cochrane, and Web of Science databases. Data were extracted and analyzed based on demographic characteristics, lipoma classification, treatment modality, complications and secondary treatment. Results: A total of 22 retrospective studies comprising 1215 patients were included. The mean age was 1.87 years, with a 1.12:1 female-to-male ratio. Dorsal lipomas were the most common subtype (31.6%). At first, a total of 1017 (83.7%) patients underwent surgery, whereas 198 (16.3%) patients had conservative management. Total resection was achieved in 422 (41.9%) patients, whereas subtotal resection and partial resections were performed in 261 (25.9%) and in 334 (33.29%) patients, respectively. Neurological worsening occurred in 17.2% of patients treated conservatively at first diagnosis, with urological dysfunction being the most common symptoms reported (15.2%), followed by neurological deficit to the lower limbs (12.6). Conservative management following prior surgical intervention was performed in 2.6% of cases. A favorable outcome was observed in 88.7% of patients following surgical resection and in 81.8% of patients who were not treated surgically. Conclusion: While surgical intervention is associated with operative risk, it provides a lower risk of long-term neurological deterioration compared to conservative management. The decision to operate should be individualized, considering patient age, anatomical complexity and based on risk of progression.
Annanepesov et al. (Mon,) studied this question.