Surgical Management for Intradural Spinal Lipoma in Adult Patients Without Spinal Dysraphism (original) (raw)
Related papers
Acta Neurochirurgica, 2010
Non-dysraphic intradural spinal cord lipomas are rare lesions and the management remains controversial. We present our experience with five cases and propose guidelines for their management. Five patients who underwent surgery for non-dysraphic spinal cord lipomas between January 2004 and April 2009 were retrospectively reviewed. All had varying degrees of neurological symptoms at the time of surgery with characteristic features on magnetic resonance imaging (MRI). All patients underwent decompression with a laminectomy/laminoplasty and debulking. The dura was primarily closed in one patient. The literature was also extensively reviewed regarding these rare lesions and optimum management guidelines proposed. The age at presentation ranged from 17 to 52 years (mean 32.2). Minimum follow-up was 8 months and maximum follow-up was 5 years. There was neurological improvement following surgery in all cases. Post-operative MRI scan showed evidence of significant residual tumour in all patients. The extent of surgical resection does not necessarily correlate with clinical outcome. The aim of surgery should, therefore, be adequate decompression with preservation of neural structures. Aggressive debulking should be avoided. Onset of any neurological symptoms/signs, bowel or bladder symptoms or intractable local symptoms should be an indication for surgery.
2004
The indications for surgery and the optimal surgical strategy for intradural spinal lipomas are still being debated. The article presents two cases of intradural spinal lipoma that were treated with subtotal resection and decompression. The patients were two adults, one with a thoracic intradural spinal lipoma and one with a lumbar lesion of the same type. Both were admitted to hospital with progressive neurological symptoms and pain. Both cases were treated with spinal cord decompression through subtotal tumor resection. The surgery resulted in immediate improvement in the neurological status of both patients. Lipomas are benign tumors that grow very slowly and may change size according to alterations in body fat level. In symptomatic cases, the surgical strategy should be decompression of the spinal cord through subtotal resection of the tumor.
Intraspinal Lipomas Without Associated Spinal Dysraphism
Iranian Red Crescent Medical Journal, 2014
The aim of this study was to report surgical strategies and clinical outcomes for thoraco-lumbar intradural lipomas. Intraspinal lipomas are rare congenital histologically benign neoplasms, which account for less than 1% of all spinal cord tumors. These tumors are most frequently found in the lumbosacral area as components of a dysraphic state, however, intramedullary lipomas are not associated with spina bifida or cutaneous malformations and have only been described as isolated cases among spinal lipomas, where the thoracolumbar region is rarely affected. Case Presentation: Three patients with thoracolumbar intradural lipomas were admitted to our clinic at different points of time. Partial resections and debulking of the tumors were achieved with the guidance of an operating microscope. We performed laminectomies or laminoplasties, for tumor resections. Discussion: Postoperatively, the patients demonstrated significant clinical improvements. In this manuscript we presented our surgical experiences for intraspinal lipomas.
Intradural Spinal Lipoma of the Conus: A Case Report
Bangladesh Journal of Neurosurgery, 2019
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
J Clin Neurosci, 2003
A case of isolated intradural spinal cord lipoma is presented. Most isolated spinal cord lipomas are intradural extramedullary, and the most common location is subpial. True intramedullary lipomas are very rare. Patient history is usually of months to years of local back pain, with recent escalation of pain and development of neurological symptoms. MRI examination shows a well circumscribed lesion of high signal on both T1 and T2 weighted images, and suppression on fat saturation sequence. Subtotal resection is the surgical aim. This improves pain but neurological symptoms rarely improve, usually are unchanged, and occasionally are worse.
Non-dysraphic intramedullary spinal cord lipoma. A case report
Joint Bone Spine, 2002
-Non-dysraphic spinal cord lipomas are rare benign lesions, accounting for approximately 1% of all spinal cord tumors. Patients usually present with long histories of disability followed by rapid progression of their symptoms. Presenting symptoms include spinal pain, dysesthesic sensory changes, gait difficulties, weakness, and incontinence. Magnetic resonance imaging is the examination of choice. The T1-and T2-weighted images show increased and decreased signal intensity, respectively. The goal of intervention is decompression and generous debulking following by duraplasty. Early diagnosis of spinal cord lipomas and early surgery is advanced prior to irreversible disease progression. One new case of true non-dysraphic cervicodorsal spinal cord lipoma is reported. Joint Bone Spine 2002 ; 69 : 511-4. © 2002 Éditions scientifiques et médicales Elsevier SAS intramedullary spinal cord lipoma / MR imaging / partial removal * Correspondence and reprints.
Total Resection of Complex Spinal Cord Lipomas: How, Why, and When to Operate?
Neurologia medico-chirurgica, 2015
This article shows the long-term advantage of total resection of complex spinal cord lipomas over partial resection and over non-surgical treatment for children with asymptomatic lipomas. The classification, embryogenesis, and technique of total resection of complex lipomas are described. The 20-year outcome of 315 patients who had total resection is measured by overall progression-free survival (PFS, Kaplan-Meier), and by subgroup Cox multivariate hazard analysis for the influence of four variables: lipoma type, symptoms, prior surgery, and post-operative cord-sac ratio. These results are compared to 116 patients who underwent partial resection, and to two published series of asymptomatic lipomas followed without surgery. The PFS after total resection for all lipomas is 88.1% over 20 years vs. 34.6% for partial resection at 10.5 years (p < 0.0001). The PFS for total resection of asymptomatic virgin lipomas rose to 98.8% vs. 60% and 67% for non-surgical treatment. Partial resecti...
Pathogenesis of spinal intramedullary lipomas: two case reports
Journal of Medical Case Reports, 2023
Background Spinal lipomas not associated with dysraphism are rare and have an unknown natural history. In this report, we describe two cases; they showed recurrence during long-term follow-up, which makes us doubt a benign malformative etiology. Case reports Two patients, a 19-year-old South American woman and a 14-year-old boy with spinal lipomas, underwent surgical resection. The lipomas were not associated with dysraphism and were located in the cervicothoracic and craniocervical junctions. In both cases, we decided to operate due to clinical progression; the former had a progressive natural course, and the latter experienced clinical worsening after recurrence from previous surgeries. The surgery took place with the assistance of neurophysiological monitoring and intraoperative ultrasound; a partial resection and medullary decompression were done, following the more recent recommendations. Discussion The natural history of these lesions is currently unknown due to their rarity and the heterogeneity in the long-term follow-up of previously reported cases. Although previous reports describe good outcomes after surgical resection, long follow-ups, especially in young subjects, may show differences in these outcomes with progression and recurrence. We contribute to this last piece of evidence by describing two more cases of progression and recurrence. Lessons Long-term close follow-up should be done in young subjects with spinal lipomas, as they are more prone to an aggressive course. Metabolism and hormonal changes may be behind this progression. Reoperation must be considered if neurological decline is detected.
Intra-Spinal Cord Lipoma without Spinal Dysraphism
Scholars Journal of Medical Case Reports
Intraspinal cord lipoma is an uncommon benign tumour with an incidence of <1% of all spinal cord tumors. It is commonly associated with spinal dysraphism. However, lipoma without spinal canal abnormalities is rare with only a few case reports in the literature. Here, we report a case of intraspinal cord lipoma without spinal dysraphism in a 17year-old male patient with progressive numbness and spastic paraplegia. Multiplanar MRI revealed a large lipoma in the dorsal spinal cord. The patient underwent surgery and was confirmed histopathologically.
Concomitant cervical and lumbar intradural intramedullary lipoma
Surgical Neurology, 2008
Background: Lipomas of the spinal cord are often a component of spinal dysraphic states. Nondysraphic intramedullary spinal cord lipomas are rare, and concomitant isolated cervical and lumbar intradural intramedullary lipomata are very rare. One patient with concomitant isolated nondysraphic cervical and lumbar spinal cord lipomata has been reported and management options discussed. Case Description: A young girl presented with insidious-onset diffuse neck pain and early myelopathic signs. Conventional radiographs were normal. Magnetic resonance imaging of the whole neuraxis revealed concomitant cervical and lumbar intradural intramedullary lipoma. Subtotal resection of the lesion was performed at both levels, after which the patient improved symptomatically and was ambulant independently. Conclusion: Concomitant intradural lipomas at 2 different locations unassociated with a dysraphic state is very rare. Magnetic resonance imaging with fat suppression study is the investigation of choice. Adequate decompression with subtotal removal is the treatment of choice.