Patients with lipomatous spina bifida have special characteristics in terms of treatment because of the close relationship with the spinal cord. The lipoma, which occurs on the dorsal side of the spinal cord, is not really a “tumor”, but a developmental error of some primitive cells (mesenchymal stem cells) at the spina bifida, which regresses into a non-functional fat-like tissue instead of turning itself into a complete vertebra. It grows together with the spinal cord and eventually fuses with the subcutaneous skin of the lower back, preventing the spinal cord from rising to its normal position as the child grows and severely stretching the ends of the spinal cord; in addition, the lipoma grows and produces compression of the spinal cord, leading to gradual necrosis of the nerve cells at the end of the spinal cord and functional abnormalities of the urinary bowel or foot. This child has an intradural lipoma with subcutaneous lipoma, and the posterior mass is adipose tissue, as shown by the arrow in the MRI below: Because the lipoma is close to the dorsal aspect of the spinal cord, treatment requires that the lipoma be removed as much as possible and that the spinal cord be minimized. This is currently seen as the most effective and least invasive surgical technique, and is particularly effective in children with large lipomas. Using CUSA as described above, the dorsal lipoma of the spinal cord can be removed relatively completely. The image below shows a postoperative review of the spinal cord MRI, which shows that the lipoma has been largely removed.