Therapy 1 (Minimal Spinal Dysraphism)

16.6-year-old teenager with a lipoma over the sacrum, abnormal hair, and retraction of the overlaying skin, known since birth, who had regular follow-ups. Due to increased growth of the lipoma the patient and her parents requested surgery. Prior to the operation, additional examinations including MRI were performed. During surgery a 2 cm thick stalk of the already prepared subcutaneous lipoma is visible which continues by a hole in the fascia in the deeper layers. Continuation of the lipoma by a missing vertebral arch and an opening in the dura to the cauda equina. Excision of the lipoma with careful consideration of cauda equina and conus, extension plasty of the dural sac and stepwise closure of the wound.