Intradural Lipoma Research Articles

EXTRAMEDULLARY EPIDERMOID IN A CASE OF MYELOMENINGOCOELE: AN UNUSUAL ASSOCIATION

Spinal epidermoid cysts are rare constituting between 0.5% to 1% of all spinal tumors but accounting for up to 10% of intraspinal tumors in children. They are most often seen in the lumbosacral spine. Males are more frequently affected than females. Epidermoid cysts arise from pathologic displacement of epidermal cells into the spinal canal. They can be acquired from trauma, lumbar puncture, surgery such as myelomeningocele closure or arise as congenital lesions, like when there is improper closure of the neural tube, which results in the inclusion of epiblasts in the neural tube. Forty percent are intramedullary and sixty percent are extramedullary. Myelomeningocele is an entity which is common in the lumbosacral region due to congenital neurulation defect. The prevalence of myelomeningocele is approximately 0.8 to 1 per 1000 live births worldwide. The anatomical location may vary as cases of cervical, cervicothoracic, thoracic, thoracolumbar, lumbar and sacral have also been documented. The sac usually contains nerve bres or neural tissues, however sometimes it may contain intradural lipoma or dermoids. Here we present a rare case of a 1 year 6 month old male child presenting with with dorsolumbar myelomeningocele with symptoms of urinary and bowel incontinence and weakness of both lower limbs found to have extrameduallary epidermoid as a content of myelomeningocoele sac. The concurrence of a congenintal neoplasm within the spinal canal associated with myelomeningocele seems to be a very rare event as very few such cases have been reported worldwide to the best of our knowledge

PEDIATRIC SPINAL DYSRAPHISM ON MAGNETIC RESONANCE IMAGING: TRENDS IN A TERTIARY CARE HOSPITAL IN NORTH INDIA

Background: Spine and spinal cord development is governed by intricate genetic mechanisms and any deviation from the normal embryological cascade during 2-6 gestational weeks causes imperfect fusion of midline mesenchymal, bony and neural structures causing spinal dysraphism. Imaging plays a pivotal role in their evaluation as many patients present with concurrent anomalies that need to be corrected simultaneously to avoid repeat surgeries. To demonstrate the spectrum of MRI ndings of spinal dysraphi Aim: Settings and design: sm. A cross sectional observational study was done in 36 pediatric patients with known or suspected spinal dysraphism on 3T MRI. MRI was Materials And Methods: performed using Siemens Skyra 3T MRI. In this study comprising of 36 patients, mean age Results: was 37.1months (3 years 1month) with minimum age of 4 days and maximum age of 18 years. Children of age less than 5 years were maximally affected. A female predominance was noted with male: female ratio of 0.9:1. Open spinal dysraphism (55.6%) was more common than closed dysraphism (44.4%). The most common dysraphism was myelomeningocele. Among open dysraphism, we also encountered 1 case each of hemimyelomeningocele and myelocele. Among closed defects, split cord malformation was most common (19.4%) as it was present with other dysraphic defects (called complex spina bida), followed by lipomyelocele (11.1%) and dermal sinus (11.1%). Among 7 cases of split cord malformation, type II (6 cases; 85.7%) was more common than type I (1 case; 14.3%). Other cases of closed dysraphism were lipomyelomeningocele, meningocele, terminal myelocystocele, intradural lipoma, lar lipoma and caudal regression syndrome. MRI is an excelle Conclusion: nt modality for dening the characteristic imaging features of each dysraphism to give a composite diagnosis.

Lipoma at Conus Medullaris without Spinal Dysraphism causing Neurological Deficit: A Rare Occurrence

It's uncommon to have an intradural lipoma without spinal dysraphism. The majority are asymptomatic, however, neurological impairments might occur. For the past six months, a 35-year-old man had been experiencing growing weakening in both lower limbs. The L1 intradural space-occupying lesion was detected during a clinical examination and radiological workup. The patient underwent surgery to address a worsening neurological impairment. The patient had fully recovered neurologically after a six-month follow-up. If the neurological damage is progressive, intradural lipomas should be surgically removed. The surgical treatment produces positive results.

A Unique Case of Concomitant Intraspinal Epidermoid Cyst and Lipoma Associated with Tethered Cord Syndrome

AbstractPatients presenting with pain in lower back and paresthesia in lower limbs may have tethered cord causing the symptomology. Tethered cord may be associated with intradural tumors causing symptoms due to progressive increase in size. Association of tethered cord with single intradural tumor is a common occurrence but, to date, only one case has been reported of tethered cord associated with intradural lipoma and epidermoid cyst. The authors would like to present a similar case in a middle-aged patient.

Prevalence and Association of Occult Spinal Dysraphism with Anorectal Malformation

Background: Anorectal malformation (ARM) is associated with occult spinal dysraphism (OSD). The guideline for screening for OSD in patients with ARM is still controversial. Objective: 1) To evaluate the prevalence of OSD in each type of ARM and to elucidate which types of ARM should be screened for underlying OSD. 2) To compare the methods used in radiologic screening for OSD, such as plain lumbosacral X-ray, spinal ultrasound (U/S), and spinal magnetic resonance imaging (MRI). Materials and Methods: The medical records of all patients with ARM treated at Siriraj Hospital between 2006 and 2016 were reviewed. Spinal dysraphism screening with lumbosacral X-ray, U/S, or MRI were performed depending on the surgeon’s request. Associated urinary tract anomalies were noted. Data of the surgical treatments, outcomes, and complications of treatments were collected. Results: Among the 204 ARM patients treated, 150 patients were screened for OSD, involving 150 lumbosacral X-ray, 65 U/S, and 39 MRI. The prevalence of OSD (n=33) in all types of ARM was 16.2%. The higher types of ARM had higher prevalence of OSD, except for vestibular fistula (20.5%). The prevalence of OSD in cloaca malformation, rectobladder neck fistula, rectoprostatic urethral fistula, rectobulbar urethral fistula, and perineal fistula were 28.6%, 33.3%, 16.7%, 12.5%, and 9.8%, respectively. Lumbosacral X-ray had a sensitivity of 51.7% and was not a good screening method. Sixteen of 65 U/S revealed OSD (24.6%). Tethered cord and syringomyelia were noted in nine and seven, respectively. Spinal MRI (n=39) revealed 27 OSD (69.2%) comprising 16 tethered cords, 12 spinal lipoma, and 10 syringomyelia. ARM associated with KUB anomalies had a statistically significant correlation with OSD. In 33 OSD, 17 patients (51.1%) were operated on. Fourteen received untethering spinal cord, while five had intradural lipoma excised. Conclusion: Patients with ARM had a high prevalence of OSD and should be screened for. U/S is the first-line method. MRI is strongly recommended in cloaca malformation, rectobladder neck fistula, rectoprostatic urethral fistula, vestibular fistula, and all ARM associated with KUB anomalies. Other types of ARM should be screened by MRI if feasible. Keywords: Spinal dysraphism, Tethered cord, Anorectal malformation

Abordaje fisioterapéutico de paciente con meningomielocele, polimicrogiria y siringomielia

Se describe el resultado de la intervención fisioterapéutica aplicada a una niña después de cirugía de corrección de malformación de la médula espinal. En el procedimiento quirúrgico se le realizó descompresión del canal raquídeo, resección de lipoma extradural e intradural y corrección de lipomeningomielocele y médula anclada con monitoreo neurofisio-lógico. La paciente había sido diagnosticada con polimicrogiria y siringomielia clasificación ASIA A y fue tratada con abordaje fisioterapéutico basado en método Vojta durante el primer año de vida, que luego se complementó con electroterapia. El objetivo de la intervención con tratamiento Vojta fue desbloquear los circuitos de la médula y el cerebro para lograr un adecuado funcionamiento del sistema nervioso central y, de esta forma, regular el tono muscular, la comunicación y las funciones musculares. Después de dos años y medio de tratamiento se logró marcha con adecuado patrón motor, lenguaje completo, escolarización, disminución en el número de cateterismos, control completo de esfínteres y clasificación ASIA E.

Syringomyelia in children with closed spinal dysraphism: long-term outcomes after surgical intervention.

The nature of the relationship between spinal cord syrinx and tethered cord is not well known. It is unclear if surgical cord untethering results in resolution or improvement of an associated syrinx. The objective of this study was to report the response of spinal cord syrinx to surgical cord untethering. The authors retrospectively reviewed all patients with a syrinx and tethered cord who presented to a single institution over an 11-year interval. Patients with open neural tube defects were excluded. Thirty-one patients were identified, 25 of whom had both clinical and imaging follow-up after surgery. Patients were grouped according to etiology of the tethered cord. Clinical outcomes and syrinx characteristics were recorded. Of the 25 patients with tethered cord, 68% (n = 17) were male. The average age at presentation was 2.5 years (0-10.1 years) and age at surgery was 3.7 years (range 1 day to 17 years). Etiologies of tethered cord were lipomyelomeningocele (n = 8), thickened/fatty filum (n = 7), intradural lipoma (n = 5), myelocystocele (n = 2), meningocele (n = 2), and diastematomyelia (n = 1). Twenty-three of the patients underwent primary untethering, whereas 2 patients had received untethering previously at another institution. The average syrinx length and width prior to surgery were 4.81 vertebral levels (SD 4.35) and 5.19 mm (SD 2.55 mm), respectively. Conus level ranged from L1 to S3. Patients were followed for an average of 8.4 years (1.35-15.85 years). Overall there was no significant change in syrinx length or width postoperatively; the average syrinx length increased by 0.86 vertebral levels (SD 4.36) and width decreased by 0.72 mm (SD 2.94 mm). Seven of 25 patients had improvement in at least one presenting symptom, including scoliosis, weakness, bowel/bladder dysfunction, and pain. Eight patients had stable presenting symptoms. Six patients were asymptomatic and 5 patients had new or worsening symptoms, which included scoliosis, pain, or sensory changes. Although some syrinxes improved after surgery for tethered cord, radiological improvement was not consistent and did not appear to be associated with change in clinical symptoms. The decision to surgically untether a cord should be focused on the clinical symptoms and not the presence of a syrinx alone. Further studies are needed to confirm this finding.

Intradural Spinal Lipoma of the Conus: A Case Report

Intradural spinal lipomas are rare, and their origin is unknown. Although the clinical presentation may not be distinctive, patients usually present with neurological deficits secondary to mass effect. Total excision may not be possible all time, although subtotal resection is easily done by microsurgery. We report a case of intradural spinal lipoma of the conus medullaries. Total excision was done under microscope and histopathology proved lipoma.
 Bang. J Neurosurgery 2019; 8(2): 112-114

Surgical strategies and outcomes for intradural lipomas over the past 20 years

Intradural lipoma is an extremely rare spinal tumor. The boundary between the spinal cord and the lipoma is usually unclear, with adhesions being firm. Thus, total resection of the tumor is difficult and the neurological prognosis after total resection is poor. Information on the management of this type of tumor is scarce owing to the limited studies that have been conducted and the low sample sizes reported. Here, we report a case and provide a review of the literature on intradural lipomas over the past 20 years. In addition to describing our case, we reviewed reports published in Pubmed and CiNii. The demographic data of the patients included in these studies were extracted and the surgical procedures were assessed, along with their corresponding postoperative outcomes. There were 57 primary cases and 4 cases of recurrence. Among the primary cases, the neurological symptoms were persistent in 54 (95%) after surgery. The postoperative outcomes after excessive (>60% tumor resection) or total resection were significantly poor. In the recurrence cases, the mean period from initial surgery to recurrence was 11 years and all initial surgical procedures involved only partial resection surgery. This report is, to the best of our knowledge, the most exhaustive analysis of cases of intradural lipomas and recurrences. The optimal treatment for lipoma necessitates both partial resection and duraplasty.

3-Tesla magnetic resonance imaging evaluation of intraspinal extramedullary nonosseous neoplastic lesions with their postsurgical and histopathological correlation

Aims: This study aimed to evaluate the diagnostic ability of 3-Tesla magnetic resonance imaging (MRI) in detection and characterization of intraspinal extramedullary nonosseous neoplastic lesions and their histopathological correlation. Settings and Design: It was a prospective study involving fifty patients who presented with low backache and lower limb weakness with MRI findings suggestive of a neoplastic extramedullary intraspinal lesion. Patients and Methods: A 3-Tesla 16-channel MRI scanner was used for imaging. Multiplanar imaging was done using T1, T2, short-tau inversion recovery sequences and T1 fat-saturated sequences. All patients then underwent postgadolinium MRI. The findings of MRI were then reviewed. An analysis of correlation between MRI findings and surgical and histopathological findings was done. Results: Out of the fifty patients evaluated, intradural lesions were noted in forty patients and extradural lesions in ten patients. Schwannoma was the most common tumor, followed by meningioma in the intradural category. Two rare cases of intradural lipoma and malignant peripheral nerve sheath tumors were also detected. In extradural category, metastasis was the most common lesion along with two rare lesions of epidural meningioma and leukemia-associated granulocytic sarcoma. Conclusions: MRI is an indispensable tool in the evaluation of spinal neoplasms. Its multiplanar capability, high-quality soft-tissue resolution, and depiction of various anatomic landmarks help the neurosurgeon to make a road map for the surgery. In most of the cases, MRI can give information regarding the histopathology of the lesion. However, in some cases, differential diagnosis needs to be included, especially in cases of extradural meningiomas and malignant peripheral nerve sheath tumors, because of their rare incidence.

Spinal Arteriovenous Vascular Malformations in Patients with Neural Tube Defects.

Neural tube defects, such as tethered cord, intradural lipoma, or myelomeningocele may coexist with spinal vascular malformations. The coexistence of these 2 rare entities is suggestive of a causal relationship between them, which may lead to further understanding of their pathogenesis. We present a series of 6 patients with epidural spinal arteriovenous fistulas associated with neural tube defects. We retrieved cases of spinal vascular malformations associated with neural tube defects seen at our institution. The clinical presentation, MR imaging/MRA and angiographic imaging, treatment outcomes, and long-term neurologic outcomes were analyzed. Descriptive statistical analyses are reported. Six patients with epidural arteriovenous fistulas and neural tube defects were included in this study. The mean age at presentation was 42 years, and the most common presenting symptoms were lower extremity weakness followed by sensory disturbances and bladder/bowel dysfunction. In most cases (5/6), the fistulas were located at the sacral level. All cases were fed by the lateral sacral artery (6/6). Four patients had prior spine surgery, but the fistula was in the operative bed in 2 cases. All fistulas were extradural with secondary intradural venous drainage. Five patients underwent transarterial embolization with Onyx, and 1 patient had a treatment-related complication. It is conceivable that there is a pathophysiologic link between neural tube defects and development of spinal vascular malformations. Delayed neurologic deterioration or high conus signal in a patient with a neural tube defect should suggest the possibility of such an association.

Adequate Decompression of Adult Lumbar Intradural Lipoma without Dysraphism Using a Monopolar Stimulation Electrode for Intraoperative Monitoring: Case Report

Adult non-dysraphic intradural spinal lipomas are rare entities. Here we report two cases of adult non-dysraphic intradural lumbar lipoma. Case 1: A 66-year-old man experienced gradual progression of sensory disturbance and numbness in the lower extremities bilaterally over the course of 2 years. Magnetic resonance imaging (MRI) suggested an intradural lipoma at T12 with no evidence of dysraphism. Adequate decompression and duraplasty were performed with intraoperative monopolar stimulation to elicit evoked electromyography responses. Case 2: A 54-year-old man with a 10-year history of lower back pain and gradual progression of weakness of the right lower extremity over the course of 2 years was referred to our hospital, where he presented with urinary disturbance. An MRI suggested intradural lipoma at L2 without evidence of dysraphism. Roentgenograms revealed L5 isthmic spondylolisthesis. Adequate resection, duraplasty, and L4-S posterior lumbar interbody fusion were performed with intraoperative monopolar stimulation monitoring. Both patients received pathological diagnoses of lipomas, and neurological symptoms improved postsurgically in both cases. Adequate resection is recommended for adult lumbar lipomas without dysraphism in order to achieve a good clinical outcome. The evoked electromyography response was a simple and useful intraoperative tool to demonstrate adequate decompression of adult non-dysraphic intradural spinal lipomas in both of these cases.

Biopsy‐Proven Spontaneous Regression of a Rhabdomyomatous Mesenchymal Hamartoma

Rhabdomyomatous mesenchymal hamartoma (RMH) is a rare, benign, congenital tumor of the dermis and subcutaneous tissue comprised of skeletal muscle and adipose and adnexal elements. Although the majority of cases are an incidental finding in otherwise healthy patients, some have been reported in association with other anomalies. We present a full-term boy evaluated on day 2 of life for two lesions located on the midline of the lower back and right buttock that each appeared clinically as an atrophic, pink plaque. Ultrasound of the midline lesion revealed an underlying lipomyelomeningocele with a tethered cord in the spinal canal. Histopathology of the right buttock cutaneous lesion was consistent with a diagnosis of RMH. Surgical excision was performed on the midline intradural lipoma and the lesion on the buttock was monitored clinically. Repeat biopsy of this site at 1 year of age revealed complete spontaneous regression. This case highlights three interesting features: the association with an occult spinal dysraphism lipomyelomeningocele and tethered cord, the clinical presentation of an atrophic plaque as opposed to the more commonly reported raised lesions, and the phenomenon of spontaneous regression of the lesion. Most importantly, this final feature of regression in our patient suggests that, in the absence of symptoms, clinical observation of RMH lesions is warranted for spontaneous regression for 1 to 2 years provided that no functional deficit is noted and that the cutaneous or deeper lesions are not causing a medical problem.

Pathological Changes and Surgical Treatment of Lipomas of the Conus Medullaris

To describe the pathological changes of lipomas of the conus medullaris and the appropriate surgical treatment for removing such lipomas for optimal reconstruction of the normal spinal cord anatomy. Data were collected on 73 patients, aged 1.5 months to 18 years, who underwent surgical removal of a lipoma of the conus medullaris at Shanghai Children's Medical Center from January 2005 to December 2008. Neurological symptoms included pain, urine and stool incontinence, and bilateral lower limb dysfunction. The surgical procedures consisted of excision of subcutaneous and intradural extramedullary lipoma, partial excision of intramedullary lipoma, detachment of the spinal cord from the dural membrane, relief of tethered spinal cord, and excision of the affected filum terminale. The main pathological changes in patients with lipoma of the conus medullaris were ventral deviation of the spinal cord caused by compression from a dorsal lipoma, traction on the spinal cord from attachment of intradural lipoma and subcutaneous lipoma, increased tight fit between the spinal cord and the dural membrane on both sides, and degeneration of the filum terminale. A total of 67 patients were followed up for 6 months to 4 years. Improvement after surgery varied among the symptomatic patients. A total of 5 patients had transient deterioration of symptoms after surgery. All asymptomatic patients remained asymptomatic. Only through thorough understanding of the pathology of the lipoma of the conus medullaris, we could optimally excise the lipoma, untether the spinal cord, reconstruct the normal anatomy of the spinal cord, and rehabilitate neurological function.

Paciniolipoma in congenital spinal dysraphism

The authors describe a case in which an intradural lipoma, causing tethering of the cord, was found on histological examination to exhibit fully differentiated mature pacinian corpuscles throughout. There are only 3 reports in the literature describing this rare tumor, and the authors use the term "paciniolipoma" to refer to it.

Transient Allodynia Following Caudal Lipoma Excision: A Case Report

Allodynia is the sensation of pain due to non-painful stimuli. It usually occurs due to destructive lesions of the spinal cord or peripheral nerves. Allodynia following intradural lipoma surgery has been reported previously. We herein report a case of allodynia developed after microsurgical caudal lipoma excision without associated spinal cord injury.

Manejo de gestante con cistoplastia de ampliación con sigma

Augmentation cystoplasties with intestinal section are used to treat some urological diseases in patients with low bladder capacity and deficient adaptation (myelomeningocele, lipomeningocele, intradural lipoma, dermoid cyst, sacrum agenesia, traumatic lesions of the spinal cord) in whom conservative measures have failed. We report the case of a 20-year-old pregnant woman with a history of myelomeningocele and neurogenic bladder, treated by ventriculoperitoneal shunt and cystoplasty. Ultrasonography showed a fetus in cephalic presentation, with normal biometric findings and severe oligoamnios. Magnetic resonance imaging revealed an augmented bladder with large bowel loop. Given the severe oligoamnios and unreactive fetal non-stress test, labor induction was started with unsuccessful results and cesarean section was performed.

Lateral tethering intraspinal lipoma with scoliosis

The authors present an unusual case of an intradural lipoma at the thoracolumbar level causing lateral tethering of the spine, with complicated scoliosis. A 6-year-old girl was admitted with progressive change in posture detected by her parents. Thoracolumbar scoliosis was detected by physical examination and X-ray studies. Spinal magnetic resonance imaging revealed an intradural lipoma and right lateral tethering of the spine at the upper lumbar level. After surgical release of lateral tethering and resection of the lipoma, fusion was performed by the orthopedic surgery team. Radiological and intraoperative findings of this extremely rare case are discussed.

Painful testicle in a young boy

<h3>BACKGROUND AND PURPOSE:</h3> Neural tube defects, such as tethered cord, intradural lipoma, or myelomeningocele may coexist with spinal vascular malformations. The coexistence of these 2 rare entities is suggestive of a causal relationship between them, which may lead to further understanding of their pathogenesis. We present a series of 6 patients with epidural spinal arteriovenous fistulas associated with neural tube defects. <h3>MATERIALS AND METHODS:</h3> We retrieved cases of spinal vascular malformations associated with neural tube defects seen at our institution. The clinical presentation, MR imaging/MRA and angiographic imaging, treatment outcomes, and long-term neurologic outcomes were analyzed. Descriptive statistical analyses are reported. <h3>RESULTS:</h3> Six patients with epidural arteriovenous fistulas and neural tube defects were included in this study. The mean age at presentation was 42 years, and the most common presenting symptoms were lower extremity weakness followed by sensory disturbances and bladder/bowel dysfunction. In most cases (5/6), the fistulas were located at the sacral level. All cases were fed by the lateral sacral artery (6/6). Four patients had prior spine surgery, but the fistula was in the operative bed in 2 cases. All fistulas were extradural with secondary intradural venous drainage. Five patients underwent transarterial embolization with Onyx, and 1 patient had a treatment-related complication. <h3>CONCLUSIONS:</h3> It is conceivable that there is a pathophysiologic link between neural tube defects and development of spinal vascular malformations. Delayed neurologic deterioration or high conus signal in a patient with a neural tube defect should suggest the possibility of such an association.

Intradural lipoma of the cervicothoracic spinal cord with intracranial extension

Intradural spinal lipoma is rare and seen about 1% of all tumors of the spinal cord. Lipomas of the cervical location with intracranial extension are extremely rare and are described as intramedullary or subpial location. A 12-year-old female with lipoma of the cervicothoracic spinal cord demonstrated progressive quadriparesis. The patient underwent surgery with decompression of the affected craniocervical location. In the reported case, we describe a rare intradural lipoma of the cervicothoracic spinal cord with posterior fossa extension in the child, and the relevant English medical literature is reviewed.