Co-occurrence of thoracolumbar intramedullary lipoma and intracranial lipoma during Gardner's syndrome: a rare occurrence.

Abstract

Dear Editor, It was with great interest that we read the paper by Kabir et al. [3] and the related papers regarding spinal cord lipomas in Acta Neurochirurgica. True intramedullary lipomas of the spinal cord are extremely rare mass lesions that have been reported only as single-case presentations [3, 4]. Intracranial lipomas are also rare, as their spinal counterparts constitute less than 1 % of intracranial mass-occupying lesions [8]. Herein, we report on a rare case of a thoraco lumbar in t ramedul la ry l ipoma wi th an accompanying intracranial lipoma on the background of Gardner’s syndrome (GS). A 50-year-old woman undergoing regular follow-up examinations due to GS was admitted to our institution with numbness in both legs and difficulty walking. Her medical history described left-sided facial asymmetry because of a known osteoma (Fig. 1) as well as epilepsy controlled with diphenylhydantoin sodium (100 mg/day). A cranial computed tomography (CT) revealed a large lipoma in the middle cranial fossa and in both cerebellopontine angles (Fig. 2a). A lumbar CT and magnetic resonance imaging (MRI) revealed a giant intramedullary lipoma measuring 13 cm in the craniocaudal direction involving the thoracolumbar cord, which caused a tethered cord (Fig. 2b–d). The neurosurgeon recommended a surgical operation after reviewing the radiological findings. However, due to the patient’s recurrent surgical procedures and persistent desmoid tumour history in the old abdominal surgical site, she refused the surgical procedure. The patient is still receiving follow-up care, taking anti-epileptic medication and undergoing regular radiological scans. GS, a variant of familial adenomatous polyposis, is characterised by intestinal polyposis, desmoid tumours, osteomas, epidermoid cysts, dental abnormalities and periampullary carcinomas [2]. Countless polyps in the colon are associated with a predisposition to develop colon cancer; if the colon is not totally removed, a total proctocolectomy is required in patients diagnosed with GS. GS is rarely associated Electronic supplementary material The online version of this article (doi:10.1007/s00701-015-2456-y) contains supplementary material, which is available to authorized users.