Surgical Management for Intradural Spinal Lipoma in Adult Patients Without Spinal Dysraphism

Abstract

Background: Spinal cord lipomas are benign lesions, accounting for less than 1 % of all spinal tumors. Objective: To evaluate the outcome of debulking surgical management of intradural spinal lipoma without spinal dysraphism. Methods: The study included 6 adult patients; 4 males and 2 females with a mean age of 40.2±8.6 years. All patients underwent full history taking, complete general and neurological examinations and radiological evaluation including plain X-ray and MR imaging. All patients underwent generous internal decompression through removal of as much as possible of the lesions leaving only tissues adherent to the spinal cord. Results: Three patients had dorsal lipomas, 2 patients had lumber lipomas and only one patient had cervical lipoma. The lipomas were found extended through one-vertebral level in 4 patients, but 4vertebral level lipoma was detected in 2 patients. Pain improved in all patients within the first two months after surgery. Motor weakness improved in 2 patients but foot drop did not improve. Parathesia and numbness improved in 4 patients; however, 2 patients still exhibited hypoesthesia. Urinary incontinence improved in one of 2 patients. Postoperative MRI showed some residual tumor tissue and a normal posterior subarachnoid space. Follow-up neurological examinations during two years revealed no abnormalities apart from hyposthesia. Conclusion: Despite intradural spinal lipomas are not a frequent spinal space occupying lesion, it is associated with varied neurological deficits and early surgical decompression without attempts for complete excision is an ideal therapeutic option associated with satisfactory neurological improvement and serial MR imaging for follow-up is mandatory. (Egypt J Neurol Psychiat Neurosurg 2010; 47(1): 207-213).