think in the, if there's one comment or question, otherwise we'll catch up on time by starting the next section. Of course. One of the things I regret is never visiting Dakling Pang to see that technique and how he did it. I scheduled several times and could never make it. But I wonder, has anyone had any success with that recommendation of his total excision of lipomas? I talked to him about this several times and I told him I thought it was impossible to do in the lipomas that I know about, but I wonder if anyone in the room has been successful in excising lipomas. I've tried and my success rate is about as good as yours, Mike. Unfortunately I've also seen patients who have undergone the total resection have been devastated. I think the numbers that Dakling reports underestimates the damage that can be done. Even in his hands. Dr. D has worked with Dakling Pang and he tells us stories about doing 18 or 20 hour surgeries trying to piecemeal remove those fatty cells with small structures. Even in Dr. D's hands, he's never done a complete resection unless he's confident or there's no changes in interruptive monitoring. I question what you said about the amount of residual lipoma and the potential for recovery versus being overly aggressive with the lipoma and ending up with that patient in the last case. I suspect that's very difficult to monitor and for us to definitively know the neural lipoma interface. I think you're very right. The goal is trying to create as much space as possible for the lipoma to grow in a very slow fashion and not cause any problems in the future. I agree with Jeff and Mike. It is extraordinarily difficult to do his operations successfully. I don't think I've had much success over my career. I caution about the symptomatic patients being operated on and what the data you guys have shown that those patients are going to deteriorate 10 years or so. Let's just say, and you had other data that showed the reoperation rate is just a mess. If you're looking at a little kid and you're saying, well, should we do it prophylactically or not? Or should we follow? It seems to me if you do an operation and you give a child neurogenic bladder, which you may give him 10 years from now, but that's 10 years the kid's not in diapers or not in the urologist and stuff like that. In my personal opinion and philosophy about neurological deficits, I think there are two things that pediatric neurosurgeons encounter and get the most grief of from parents. One is a facial nerve palsy, which is very disruptive, and two is a neurogenic bladder. In my opinion, obviously nobody's happy about being hemiplegic either, but it's just a mess to take a normal child and ruin their face or make them in diapers when they're going to school. So I grew up in an era of seeing lipoma, tethered cord, picture, operate on it. And then over the course of my career I've been extremely conservative to operate on only those that were symptomatic because I've seen all the other disasters that happened, and I try to avoid them as much as possible. Thank you to all our presenters and questions. We're going to move on.

Dakling Pang

lipoma removal technique

total excision of lipomas

damage and effects of complete resection

conservative approach to lipoma surgery