Spinal cord lipoma without dysraphism in the infancy that extends intracranially. Case report and review of the literature

Pathogenesis of spinal intramedullary lipomas: two case reports

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.

A Rare Case of Intramedullary Lipoma of Brainstem to Thoracic Cord--What to Do?

Introduction:

Intramedullary lipomas are rare, representing 1% of spinal cord tumors. There are less than 25 case reports about cord lipoma extending into brain. Due to paucity of literature, etiology and management are not well established.

Case report:

A 14-month-old baby girl was brought with complaints of torticollis toward right side, left upper limb monoplegia, and swallowing difficulty for 6 months. Magnetic resonance imaging brain and spine confirmed the diagnosis of cervicothoracic intramedullary lipoma extending till pontomedullary junction, invading subcutaneous fat. She underwent partial resection of lesion along with decompression. The recovery was good.

Conclusion:

Such lipoma needs extensive pre-, intra-, and postoperative planning. The goal should be decompression, rather than excision. Outcome is good with partial resection.

Non-dysraphic intramedullary lipoma of the craniocervical region in an adult: Case report

Intradural spinal lipomas with intracranial extension are very rare and are typically diagnosed in childhood. Radical surgical excision usually causes a high rate of morbidity because of the firm adherence between the lipoma and neural tissues. In this report, we present a case of craniocervical intradural intramedullary lipoma in an adult patient. The patient underwent surgery with excision of the mass, leaving a sheet of lipoma on the tumor bed.

Intradural lipoma of the cervicothoracic spinal cord with intracranial extension

INTRODUCTION

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.

CASE

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.

DISCUSSION

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.