Spinal Cord Lipomas Research Articles

Bridging the spinal dysraphism spectrum between terminal myelocystocele and spinal cord lipoma: a report of two cases of true terminal lipomyelocystocele with holo-cord syrinx.

Terminal myelocystocele (TMC) is a rare form of spinal dysraphism which arises due to aberration in the secondary neurulation process involving the caudal cell mass. Terminal myelocystocele has been defined by Pang et al. based on essential and non-essential features. One of the non-essential features includes non dysraphic lipomas which do not tether to the neural placode. We are presenting two cases which meets all the essential criteria outlined by Pang et al. for TMC but also show the presence of a lipomatous component tethering to the neural placode, similar to a dysraphic lipoma. Through this article, we want to showcase a subset which represents "true" terminal lipomyelocystocele (TLMC), bridging the spectrum of spinal dysraphism between TMC and lipomyelomeningocele (LMM).

Nondysraphic Intramedullary Spinal Cord Lipomas in the Adult Population

ObjectiveIntramedullary spinal cord lipomas without spinal dysraphism are rare. Although they are benign tumors, they can cause significant neurological deficits. Their tight adherence to the spinal cord presents a challenge for resection. Therefore, we review our institutional experience treating adult patients with intramedullary lipomas in the absence of dysraphism and report long-term outcomes after resection. MethodsAll adult patients undergoing resection of intramedullary spinal cord lipomas at a comprehensive cancer center between June 2011 and June 2023 were retrospectively identified. Patients with spinal dysraphism or extramedullary lipomas were excluded. Patients were included if they had microscopic surgical debulking with tissue sampling confirming the diagnosis. ResultsSix patients were identified with a mean age of 35.0±11.5 years and 67% were female. Four cases localized to the thoracic spine. Symptoms included pain, numbness, and lower extremity motor weakness; only one patient reported bowel and bladder dysfunction. All patients experienced transient neurological decline in the immediate post-operative period. Five recovered to independent ambulation at long-term follow-up, including one recovering to full strength. One patient required a repeat resection after four years due to tumor progression and functional decline. Tumor progression was not recorded in the other patients. ConclusionsSubtotal resection is a safe and effective treatment. Detethering of the spinal cord, resection of exophytic components, and tumor debulking can improve symptoms and prevent further deterioration in most cases. The resection can be assisted using a laser to vaporize the fatty tissue of the lipoma without physical manipulation of the spinal cord.

Unveiling the Uncommon: Intradural Extramedullary Cord Lipoma Inducing Chest Wall Pain in a Middle-Aged Female Patient-A Case Report

BACKGROUND: Intradural extramedullary lipomas are rare spinal cord tumors that remain asymptomatic until compression of the spinal cord results in neurological symptoms. Anterior chest wall pain as the initial presentation is uncommon and can contribute to the delayed diagnosis, as it prompts clinicians to rule out other pathologies. CASE REPORT: The patient is a 44-year-old woman who presented with chronic anterior chest wall pain, instability, imbalance, and upper motor neuron signs. Imaging was obtained, and magnetic resonance revealed an intradural extramedullary mass composed of adipose tissue from T2 to T5, indicative of a spinal lipoma. Subsequently, the patient underwent complete excision and laminoplasty successfully, immediately improving all symptoms. CONCLUSIONS: Diagnosing intradural extramedullary lipomas is intricate and often incidental, with varied presentations depending on tumor localization and size. While uncommon, it is crucial to maintain a heightened level of suspicion when evaluating persistent, unexplained pain resistant to conservative treatments and accompanied by neurological symptoms. KEY WORDS: Chest wall pain, spinal cord lipomas, case report

Non-dysraphic intramedullary spinal cord lipoma: A case report

Introduction: Intramedullary nondysraphic spinal lipomas are extremely rare among primary spinal cord tumors. These patients present with nonspecific sensory symptoms followed by deterioration of motor symptoms. As the safety margins for neurological preservation are thin, meticulously locating the extent of the tumor and choosing the resection modalities is essential. Case Report: We report a rare case of a 35-year-old male who presented with progressive difficulty in walking for six months associated with numbness and tingling sensation in the bilateral upper and lower limbs. He was diagnosed with nondysraphic intramedullary cervicothoracic lipoma and underwent subtotal resection of the tumor. Conclusion: Nondysraphic intramedullary spinal cord lipomas are rare and may present as nonspecific neurological symptoms. Hence, they should be considered differentials of intramedullary spinal cord tumors. Surgery appears to be the mainstay of treatment.

Results of Surgical Treatment of Occult Spinal Dysraphisms-A Single Centre Experience.

Occult spinal dysraphisms (OSDs) are caused by various defects in the embryogenesis of the spinal cord and represent an obstacle to the ascent of the conus, which allows the conus to pass from the lower levels of the spinal canal to the final position between L1 and L2 during normal foetal life. When an OSD tethers the spinal cord at the lower levels, it can lead to neurological symptoms, better known as tethered cord syndrome. Surgical treatment of OSD is primarily aimed at untethering the spinal cord. In asymptomatic patients, this can protect against the long-term development of neurological deficits. In symptomatic patients, this can halt or limit the progression of existing symptoms. The aim of this study is to examine all paediatric and adult patients diagnosed with OSD and treated in the Department of Neurosurgery at the University Medical Centre Ljubljana during the 5-year period of 2016-2021. All patients diagnosed with OSD during this period were included in the study. Patient characteristics, treatment modalities and outcomes were studied with the aim of describing the differences between the paediatric and adult population and defining the rationality of treating these pathological conditions. We included in the study 52 patients with 64 occult dysraphic lesions. Adults (>18 years old) represented 15/52 (28.8%) of all patients, while 37/52 (71.8%) were children. The most common OSDs were conus lipomas, followed by dermal sinus tracts, filum terminale lipomas and split cord malformations. Surgical treatment was performed in 35/52 (67.3%) cases, while conservative management was chosen in 17/52 (32.6%) cases. The preoperative presence of symptoms was statistically higher in adults than in children (p = 0.0098). Surgery on complex spinal cord lipomas was statistically related to a higher rate of postoperative neurological complications (p = 0.0002). The treatment of OSD is complex and must be based on knowledge of the developmental anomalies of the spine and spinal cord. Successful surgical treatment relies on microsurgical techniques and the use of neuromonitoring. Successful treatment can prevent or limit the occurrence of neurological problems.

Spinal cord lipomas: lessons learned in the era of total resection.

Recent years have seen a paradigm shift towards total/near-total resection in spinal cord lipoma surgery. As this procedure is technically challenging, surgical candidates need to be selected appropriately through accurate image assessment and classification. The purpose of this paper is to describe a surgical series of paediatric spinal cord lipomas, their diagnosis, results and complications. We undertook a retrospective review of paediatric patients with spinal cord lipomas who underwent surgery between 2008 and 2022. The variables studied were age, gender, preoperative symptoms according to the Necker Functional Score (NFS), type of lipoma according to Morota's classification, functional and radiological surgical outcomes using the cord-sac ratio (CSR), need for re-operation, complications and follow-up. A total of 25 patients (average age 36months) underwent surgery. According to Morota's classification, MRI showed 13 type 1 lipomas, two type 2, two type 3 and eight type 4. The preoperative NFS was 16.06, with urological abnormalities being the most frequent manifestation. Total/near-total resection was attempted since 2015. Five patients with type 1 lipoma required re-operation due to clinical deterioration with suspected retethering, all of them with a CSR > 0.3. The series average CSR was 0.417. This paper highlights the importance of proper classification for a correct surgical approach to obtain favourable results and minimise possible complications. Based on our experience, given our results regarding the percentage of fistulae and retethering rates, we limited radical resection to symptomatic type 1 lipomas. Our future aim is to obtain better CSR rates and to decrease the retethering percentage.

Non-dysraphic intramedullary spinal cord lipoma of the child: Report of 3 cases

Background and purposeNon-dysraphic intramedullary spinal cord lipomas (NDSCL) represent 1% of spinal cord tumors. They are less frequent than dysraphic spinal cord lipomas and clinical presentation is unspecific. There are no guidelines on surgical management. Material and methodsWe report three observations of NDSCL in children, focusing on the clinical presentation, surgical management and postoperative outcome. ResultsThe patients, one female and two males, aged from 5 months to 10 years presented with neurological deterioration, pain, spinal rigidity and in two cases, a subcutaneous mass. Spinal MRI found intradural lipomas without spina bifida, located in the cervico-thoracic area in all cases. The lipoma extended to the medulla oblongata in two cases and was in the lumbar region in the third. These lipomas were massive, requiring decompression surgery. Surgery confirmed the lipoma to be subpial. We performed debulking of the lipoma without attempting total resection, and with or without dural plasty and laminoplasty, followed by minerva cast in two cases, and avoidance of standing in the youngest. Satisfactory recovery occurred in all three cases. After a follow-up between 4 months and 9 years, the outcome was favorable in all cases, and no patient presented with secondary spinal deformation or lipoma progression. ConclusionNDSCL is a rare entity, which often manifests with progressive pain and neurological deficits. In our experience, partial resection with or without dural plasty and laminoplasty has been associated with satisfactory postoperative outcomes and no recurrence of symptoms. We should be attentive to the risk of postoperative spinal deformity in these young patients.

Transition from partial to near-total/radical resection of spinal cord lipomas.

The objective of this retrospective study was to compare the outcomes and associated complication rates in the surgical management of spinal cord lipomas following a change of practice within our institution from partial resection (PR) to near-total/radical resection (NTR). Twenty-four children underwent surgical treatment for symptomatic spinal cord lipomas between 2009 and 2020. The near-total/radical resection group included 20patients with spinal cord lipomas and the comparison group included 6 patients with spinal cord lipomas who underwent partial resection. Filar lipomas were excluded. The mean age of the patients was 7years (range 1-14years). Post-operatively, a higher proportion of NTR patients (17/20, 85%) demonstrated improvement or stabilisation in Necker-Enfants Malades scores compared to PR patients (3/6, 50%) with a mean follow-up of 48 and 108months respectively. Two patients underwent re-do untethering surgery, both of which initially underwent partial resection surgery. Complication rates did not significantly differ between the two groups. Our data supports the view that near-total/radical resection should be considered the technique of choice over the conventional method of partial resection for spinal cord lipomas with no significant increase in complication rates.

Spinal cord lipomas in children: surgical resection and outcome

Spinal cord lipomas in children: surgical resection and outcome

Teaching NeuroImage: Lower Limb Muscle Weakness Due to Intramedullary Spinal Cord Lipoma.

A 24-year-old man presented with a 6-month history of weakness of the right lower limb, without upper extremity weakness. Spinal cord CT/MRI showed an extensive intramedullary lesion from C7 to T4, with classical radiologic features of lipoma (Figure). There was no spinal dysraphism. Subtotal resection of the lesion was performed. The pathology confirmed the diagnosis of lipoma. Postoperatively, the patient's motor function temporarily deteriorated. The symptoms improved after 2-month rehabilitation. Nondysraphic spinal intramedullary lipomas are extremely rare, constituting approximately <1% of all intraspinal tumors.1,2 MRI is the most sensitive imaging protocol; typical radiologic appearances can confirm diagnosis and avoid biopsy.

Recurrent Tethering in Conus Lipomas: A Late Complication Not to Be Ignored

Recurrent symptomatic tethered cord (RTC) is a long-term complication of spinal cord lipomas, responsible for progressive motor deficits, urologic dysfunction, and aggravation of spinal deformities. We retrospectively analyzed all cases of recurrent tethering after spinal cord lipoma surgery, the clinical and radiologic features that led to the diagnosis, the surgical management, and the neuro-orthopedic outcome at the last follow-up. The study was carried out over 20 years on 209 pediatric patients from a single institution, initially treated for a conus lipoma. Nine patients (4.8%) were surgically treated for an RTC. The age at retethering ranged from 2 to 12 years (median, 7.4 years). The time until the first and the second surgical procedure ranged from 19 to 140 months (median, 92 months [7.5 years]). The follow-up period after the second surgery ranged from 3 months to 13 years (median, 50 months). Regarding symptoms, pain responded well to surgery. Gait disturbances improved in 50% of patients after surgery. One patient with bladder dysfunctions also improved. The remaining patients maintained their presurgical status. When RTC is confirmed, the child should be referred to surgery as soon as possible, because we show that the postoperative clinical outcome improved and surgery did not worsen patients' condition. Follow-up should be as long as possible for these patients.

Nondysraphic Intradural Spinal Lipoma: A Rare Case in a Child

Lipoma is a rare and benign tumor, with lesions associated with spinal dysraphisms. The reported case is about an 8-month-old child who arrived at the hospital with developmental delay, excessive crying, undergoing MRI and reported spinal cord lipoma. Intradural lipomas without association with dysraphism are difficult to diagnose, being the most accurate form of MRI.

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

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

Perspectives on Spinal Dysraphism : Past, Present, and Future.

This article recounts the author’s personal views and recollections of the history, conception of embryogenetic theories, application of intraoperative electrophysiology, and development of prospective treatment recommendations of several important spinal dysraphic malformations, including limited dorsal myeloschisis, dermal sinus tract, retained medullary cord, terminal myelocystocoele, and complex spinal cord lipomas.

Surgical Management of Complex Spinal Cord Lipomas : A New Perspective.

This review summarises the classification, anatomy and embryogenesis of complex spinal cord lipomas, and describes in some detail the new technique of total lipoma resection and radical reconstruction of the affected neural placode. Its specific mission is to tackle two main issues surrounding the management of complex dysraphic lipomas : whether total resection confers better long term benefits than partial resection, and whether total resection does better than conservative treatment, i.e., no surgery, for asymptomatic lipomas. Accordingly, the 24 years progression-free survival data of the author and colleagues’ series of over 350 cases of total resection are compared with historical data from multiple series (including our own) of partial resection, and total resection data specifically for asymptomatic lesions are compared with the two known series of non-surgical treatment of equivalent patients. These comparisons amply support the author’s recommendation of total resection for most complex lipomas, with or without symptoms. The notable exception is the asymptomatic chaotic lipoma, whose peculiar anatomical relationship with the neural tissue defies even our aggressive surgical approach, and consequently projects worse results (admittedly of small number of cases) than for the other two lipoma subtypes of dorsal and transitional lesions. Prophylactic resection of asymptomatic chaotic lipomas is therefore not currently endorsed.

Surgical management of complex spinal cord lipomas: how, why, and when to operate. A review.

This review summarizes the classification, anatomy, and embryogenesis of complex spinal cord lipomas, and it describes in some detail the new technique of total lipoma resection and radical reconstruction of the affected neural placode. Its specific mission is to tackle two main issues surrounding the management of complex dysraphic lipomas: whether total resection confers better long-term benefits than partial resection and whether total resection fares better than conservative treatment-i.e., no surgery-for asymptomatic lipomas. Accordingly, the 24-year progression-free survival data of the author and colleagues' series of over 300 cases of total resection are compared with historical data from multiple series (including the author and colleagues' own) of partial resection, and total resection data specifically for asymptomatic lesions are compared with the two known series of nonsurgical treatment of equivalent numbers of patients. These comparisons amply support the author's recommendation of total resection for most complex lipomas, with or without symptoms. The notable exception is the asymptomatic chaotic lipoma, whose peculiar anatomical relationship with the neural tissue defies even this aggressive surgical approach and consequently projects worse results (admittedly of a small number of cases) than for the other two lipoma subtypes of dorsal and transitional lesions. Prophylactic resection of asymptomatic chaotic lipomas is therefore not currently endorsed.

Giant bipolar intramedullary nondysraphic spinal cord lipoma: A case report

IntroductionIntramedullary spinal cord lipomas (IMSCL) are a rare entity, accounting for less than 1% of spinal tumors. Most cases are associated with lumbosacral dysraphism and occur predominantly in the pediatric population. Material and methodWe report the case of an isolated bipolar lipoma, which was very large in the cervicodorsal region and small in the conus medularis. The patient was a 9-years-old male who had muscle weakness for approximately 6 months. MRI showed a hyperintense lesion on T1, which was less intense on T2, without contrast enhancement at the cervicodorsal location and the conus medularis. At his admission, the patient experienced severe decompensation with flaccid tetraplegia and abdominal respiration. He immediately underwent decompression and partial resection of the cervical lesion. The anatomical pathology evaluation confirmed the diagnosis of a lipoma. Discussion/conclusionThe possibility of quality resection of intramedullary spinal cord lipomas is controversial due to the lack of a cleavage plane with the anterior tracts. Any attempt at total resection would expose the patient to the risk of neurological worsening which is often irreversible. In our case, the surgical indication was self-imposed, the main objective of which was decompression.

Thoraco-lumbar nondysraphic intramedullary spinal cord lipoma with an unusual aspect on MRI

Intramedullary spinal cord lipomas are very rare spinal tumors, most of them related to spinal dysraphism. We report the case of an oligosymptomatic patient, presenting with a thoraco-lumbar nondysraphic intramedullary spinal cord lipoma, with an unusual biphasic sign on T1-weighted MRI, and submitted to microsurgical biopsy. Features of origin, evolution, diagnosis and treatment are discussed.

The meta-analysis of surgical treatment of pediatric asymptomatic lipomas in the spinal cord

Objective To explore the risk and significance of prophylactic surgery in the treatment of asymptomatic pediatric spinal cord lipomas. Methods We collected and reviewed studies of asymptomatic spinal cord lipomas in children from databases including PubMed, Embase, Scopus, Web of Science and Cochrane databases. RevMan5.3 and R software were used to conduct comparison between cases undergoing prophylactic surgery and those who were followed up without operations. Results Five non-randomized controlled studies were reviewed and reported a total of 403 patients followed up for 4.4-10.0 years, among whom 124 patients received merely follow-up including 32 (25.8%) cases demonstrating neurological deterioration. The other 279 patients received prophylactic surgical treatment and 30 (10.8%) reported neurological dysfunction. The difference was statistically significant (P=0.05). At the same time, 9 literatures of merely surgery (278 cases) and 1 report (56 cases) of natural history were combined. The rate of neurological dysfunction was 10.0% post operation, which was significantly different from 28.6% (16/56) in the group with only follow-up based on the random effect model (P<0.01). Conclusion For asymptomatic spinal cord lipomas in children, limited literatures have suggested that prophylactic surgery might be beneficial to prevention of neurological deterioration, which needs evidences with large sample sizes in future research. Key words: Neural tube defects; Asymptomatic diseases; Neurosurgical procedures; Child; Meta-analysis; Lipoma

Intramedullary lipoma of the cervico-thoracic spinal cord

Most of the spinal cord lipomas reported in the literature are intradural extramedullary, and true intramedullary lipomas are very rare. We present a case of intramedullary spinal cord lipoma of the cervico-thoracic region with extensions over many spinal segments. Magnetic resonance (MR) examination showed an intramedullary lipoma of the cervico-thoracic spinal cord of both high T1 and T2-weighted signal intensity and suppression on fat saturation sequence. MR imaging assessment is critical in the detection of intramedullary lipomas which may present without any neurological deficit at an early stage. Early diagnosis may lead to prevention of the irreversible deterioration of neurological functions.