Corrective Approach in a Rare Case of Isolated Lipomyelomemingocele before First birthday celebration (original) (raw)
Related papers
Scholars Journal of Medical Case Reports, 2021
Lumbosacral lipomasrepresent the most common forms of occult spinal dysraphism. Lipomyelomeningocele is a rare birth defect of the spine. It's a lipoma that is tightly attached to the dorsal surface of a neural placode and extend dorsally through spina bifida to be continuous with subcutaneous fat. MRI plays an essential role in the diagnosis and treatment. We report the case of an 18-month-old infant in whom we detected a lipomyelomeningocele during the exploration of scoliosis.
Spinal lipomas: clinical spectrum, embryology, and treatment
Neurosurgical FOCUS, 2007
CCULT SPINAL DYSRAPHISMS are a broad collection of malformations loosely grouped together by their common characteristic of being skin covered. Spinal lipomas, in particular lipomas of the conus medullaris and terminal filum, are the most common form of occult spinal dysraphism, and within this subgroup there is a remarkable spectrum of disease with regard to anatomy, clinical presentation, and treatment options. These lesions, however, are united by a similar embryology and pathological mechanism by which symptoms arise.
Lipomyelomeningocele Lumbosacral: A Case Report
Lipomyelomeningocele (LMMC) is a type of congenital occult spinal dysraphism consisting of the presence of lipomatous tissue attached to the dorsal spinal cord, which protrudes though a spinal defect along with the menings or spinal cord to form a posterior mass under the skin. LMMC is the commonest cause of congenital tethering (tethered cord syndrome) and causes neurological deterioration due to the conus medullaris and root ischemia. Here we presented a 6 year old girl with a lump over the back region since birth. The lump was progressively increasing in size. There was history of urinary and fecal incontinence since birth. Local examination of the lumbosacral region revealed a single lump with no redness over it, spherical in shape, 12×10 cm in size, soft consistency, and fixed. CT Scan of lumbosacral spine was done which revealed soft tissue mass at lumbosacral that connected with defect canal sacral from L5 until S2. We diagnosed patient with lipomyelomeningocele. Surgery was performed and there are no post operative complications and now after 1 month of surgery the symptoms were improved. Lipomyelomeningocele is rare case in our Department. Surgical treatment is indicated because the patient had urinary disturbance. There are no post operative complications and now after 1 month of surgery the symptoms were improved.
Congenital Spinal Lipoma : Analyzing the Perplexed Nomenclature and Our Management
Journal of the Royal Medical Services
Objectives: In this analysis, we will investigate the epidemiological features of spinal lipomas diagnosed at a single institution. Methods: This study was carried out by reviewing retrospectively the: patient's admission records, neuroimaging, operation records, and outpatient files and biopsy results were used to collect the data from all consecutive patients treated in single referral center. Patient data were extracted from the King Hussein Medical Center (KHMC) Primary Spinal Tumors electronic Database, between 2006 and 2016. Results: Our cohort consisted of 33-females (55.93%) and 26-males (44.06%), mean age: 3.45 ± 1.74 years. The congenital spinal lipomas were categorized into: 40-conus lipomas (17-terminal, 15-transitional, 8-dorsal) and 19-filum lipomas, including 11-patients who had lipomyelomeningocele. The most common promoter for diagnosis was skin stigmas (46.26 %), followed by associated malformations (30.63 %), and symptoms (23.11 %). Prophylactic surgery was undertaken in selected cases. In the initially asymptomatic group, 6-patients (28.57%) had late neurological deterioration. Of the 8-patients with asymptomatic conus lipomas, 3-cases (37.50%) developed sphincter dysfunction and motor problems at long-term follow-up. In the symptomatic group, 67.50% improved, 20% remained unchanged, and 12.50 % had late neurological deterioration. None of the 6-patients with symptomatic filum lipoma deteriorated postoperatively. Postoperative complications developed in 9 patients (13.55 %): seven transient local problems, 2 definitive urological deterioration. Conclusion: Despite the lack of knowledge regarding the precise natural history of lumbosacral lipoma, in these lesions, the chances of developing neurological deficits increase with increasing age at presentation. Management of congenital spinal lipomas is challenging. Surgery remains the standard treatment. However, literature regarding the role of prophylactic surgery is scanty.
Classification of Spinal Lipomas Based on Embryonic stage: Overview and Case Series
Pan Arab Journal of Neurosurgery
BACKGROUND: Unsuccessful primary neurulation is usually considered to be the main origin of spinal lipomatous malformations. Yet, we are not able to clarify many of its characteristics using this hypothesis. A new system of spinal lipomatous malformations categorization based on embryological development observed in the course of the first and second stages of neurulation process may be more realistic. OBJECT: The aim of this study was to introduce our experience in the surgical treatment of spinal lipoma correlated with the most recent classification by Morota. METHODS: This study is a retrospective clinical study of 39 cases of spinal lipoma who have been subjected to surgery from August 2007 to May 2019 in neurosurgery department in our institution. The authors classified them to four categories depending on neural tube evolution in the course of embryological growth. Category one is characterized by failing in the first stage of neurulation process; category two includes failing between the first and second stages of neurulation process; category three is characterized as failing in the beginning of the second stage of neurulation process; and category four is characterized as failing in the end of the second stage of neurulation process. We will evaluate the application of this new categorization system. RESULTS: Twenty-one cases of category one, ten cases of category two, six cases of category three and two cases of category four were included in the study. Filar spinal lipomatous malformations were included in category four. Concomitant anomalous disorders were detected only for categorizes 2-4 lipomatous malformations involving failing in the second stage of neurulation process. Only cases with category one lipomatous malformations underwent complete excision. CONCLUSION: Conus medullaris and filum terminale are usually affected in spinal lipomatous malformations and they are the products of the second stage of neurulation process. Evolution of spinal lipomatous malformations looks as an ongoing mechanism involving the first and the second stages of neurulation in some cases. Total excision was feasible for category one only.
Lumbar Lipoma and Occult Lumbar Dysraphism [Article in English]
The Central European Journal of Paediatrics, 2007
Lipomas in the form of a human tail in the lumbar region with occult spinal dysraphism constitute a very rare dysraphic spiÂnal abnormality, which is seldomseen in daily practice. This clinical entity commonly presents with local changes alone, and usually lacks neurological manifestations, although life-long risk of neurological deterioration is not negligible. Surgical inÂtervention for asymptomatic lipoma of the conus medullaris has been an area of controversy, primarily due to the scarcity of detailed studies regarding the natural history of this disorÂder. Nevertheless, the presence of esthetic or functional disorÂders warrants surgical removal of these superficial masses. We report the case of a 10-year-old boy seen initially as an infant because of a lumbar appendage that caused only esthetic conÂcern. At that time, the child’s parents refused surgical removal of the malformation. Ten years afterwards, the patient himself presented our outpatient clinic requesting the ...
Anatomo-Radiological Patterns of the Tethered Spinal Cord With Lipoma
2018
Background and Aim: Tethered spinal cord is the most common anatomic deformity which is usually diagnosed in childhood. This study aimed to describe the different anatomo-radiological patterns of the tethered spinal cord with lipoma. Methods and Materials/Patients: We conducted a retrospective and descriptive study in Neurosurgery Department of General Grand Yoff Hospital and the Neurosurgical Clinic at Fann University Hospital of Dakar, Senegal. Eight patients with spinal cord lipoma underwent surgery in these medical centers from July 2007 to January 2011. Anatomo-radiological and clinical data of the patients were collected and analyzed. Results: The mean age of the patients was 4 years ranging from 45 days to 30 years. Male to female ratio was 0.6. The symptomatic triad of median cutaneous signs, orthopedic, and sphincter disorders was found in 2 (25%) patients. Neuroimaging, mainly MRI, showed conus medullaris lipoma in 7 (87.5%) cases, and a filum terminalis lipoma in 1 (12.5%) case. All patients had a tethered spinal cord with a low-lying conus medullaris. The dehiscence of posterior lumbosacral and sacral vertebral arches was noted in 7 (87.5%) cases and scoliosis and scalloping each in 1 case. All patients were operated and the outcome was good for 5 (62.5%) patients. No death has been reported. According to surgical findings, the patients were grouped in the modified Chapman's classification. Conclusion: In comparison to myelomeningocele, tethered spinal cord with lipoma is a rare condition. Health practitioners should be aware of this condition when facing a child or a young adult patient bearing a median lumbar sacral cutaneous stigmata associated with or without lower limb orthopedic abnormalities and or sphincter disorders. Ultrasound and MRI are good diagnostic tools for the newborn allowing to make good surgical planning. However, MRI is reportedly more sensitive and the surgical option for asymptomatic cases has remained controversial. To our experience, the surgical findings can provide comprehensive information on the interface between the lipoma and the neural structure.
Dorsal epidural spinal lipomatosis
Case Reports, 2011
The authors report a case of a thoracic epidural spinal lipomatosis causing severe neurological defi cits along the review of pertinent literature. The patient is a 56-year-old woman who presented with acute onset of severe paraparesis; she was investigated with cervical and thoracic MRI and then surgically managed because of an intraspinal mass compressing the cord. The operation consisted in the excision of the mass confi rmed to be a fi brolipoma by pathological analysis. The patient attained complete neurological recovery and at 18 months follow-up she reported a generalised well-being. Thoracic lipomas are rare lesions that presenting mostly with back pain; however, in rare instances they may cause progressive and/or abrupt neurological dysfunction. Appropriate imaging can help in the diagnosis and management of such cases.