Intramedullary lipoma without spinal dysraphism in an adult: A case report& review of literature

Ravi Ichalakaranji,Rajesh Shenoy

doi:10.18231/2455-8451.2018.0050

Abstract

Intramedullary lipoma without spinal dysraphism in an adult: A case report& review of literature - IJN- Print ISSN No: - 2581-8236 Online ISSN No:- 2581-916X Article DOI No:- 10.18231/2455-8451.2018.0050, IP Indian Journal of Neurosciences-IP Indian J Neurosci

Highlights

Spinal cord lipomas are rare benign tumours[1,7,10,15] and mainly of 2 types. Those usually associated with the syndrome of spinal dysraphism,[16,22] where these lesions communicate with subcutaneous lipomas through a defect in the posterior elements of the spine and those without spinal dysraphism.[7]
Spinal cord lipomas which are not associated with spinal dysraphism are even less frequent, accounting for 1% of spinal cord tumours.1,15,23 60% are localized intradurally& 40%, extradurally.[5,9]
When early clinical signs of recurrence develop, with radiological evidence, early re-operation should be done to prevent from developing a fixed neurological deficit. Since these lipoms are very slow growing tumors, the greatest drawback of MR imaging is its ineffectiveness post-operatively due to difficulty in differentiating recurrence from residual tumour, which is always present in cases of intramedullary lipomas, since total resection of these tumors is not feasible.[3]

Summary

Introduction

Spinal cord lipomas are rare benign tumours[1,7,10,15] and mainly of 2 types. Those usually associated with the syndrome of spinal dysraphism,[16,22] where these lesions communicate with subcutaneous lipomas through a defect in the posterior elements of the spine (such as spina bifida, lipomyelomeningocele, myelomeningocele, diastematomyelia, cutaneous lipoma, fistula, pilosity&klippel-Feil malformation) and those without spinal dysraphism.[7]. There is no agreement on the indications for surgery in these cases,[14,24] especially those well preserved neurologically and/or with minimal symptoms,and the management remains a challenge.[6] Despite their benign nature, lipomas are usuallynot amenable to complete resection[11] as complete adhesion to the spinal cord limits extent of resection.[21] Attempts at radical resection carry a significant risk of morbidity, as there is usually NO cleavage plane between the lipoma and the spinal cord.[14,24] the main goal of surgery, is not total removal of the lesion,[5] but subtotal resection of the tumour & decompression of the adjacent neural structures.[5,14] It stabilizes the disease process in the long run. Histopathology Report: Showed fragments of mature adipose tissue lobules with a few nerve funicles and thick walled blood vessels

Findings

Discussion

Conclusion