Large intramedullary lipoma of the cervical cord and posterior fossa. Case report

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.

Intradural Lipoma at the Craniocervical Junction Presenting with Progressing Hemiparesis: A Case Report

Intradural spinal lipomas are rare in an adult population. They are mostly asymptomatic and usually associated with spinal dysraphism in a pediatric population. We report a rare case of spinal lipoma without dysraphism and with progressing hemiparesis. A 60-year-old woman had incidental lipoma at the craniocervical junction observed for more than 5 years. Recently, she developed right-sided hemiparesis and sensory disturbance. Radiological studies revealed a large lipoma compressing the dorsal medulla and C1–C2 spinal cord. Standard midline suboccipital craniotomy and C1 laminectomy were performed, and the lipoma was removed subtotally. The lipoma showed severe adhesion to the dorsal medulla and C1 spinal cord; therefore, the excision was limited as internal debulking. Her neurological deficit subsided within 6 months after the decompressive surgery. Considering the benign nature of lipoma, internal decompression is a reasonable management for this lesion.

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.

Cervical intramedullary spinal cord lipoma

Background

Intramedullary, nondysraphic, spinal cord lipomas are rare and account for less than 1% of all spinal cord lesions. Symptoms typically consist of a progressive myelopathy associated with increasing degrees of paralysis (e.g., quadriparesis/plegia, paraparesis/plegia).

Case Description

A 39-year-old male, without a history of spinal dysraphism, presented with a progressive spastic quadriparesis. This was attributed to magnetic resonance-documented large intramedullary cervical lipoma. Following partial intramedullary surgical debulking of the lesion, the patient neurologically improved.

Conclusion

Partial debulking of a cervical intramedullary lipoma in a patient who originally presented with a severe quadriparesis resulted in significant neurological improvement. Notably, utilization of intraoperative ultrasonography, CO₂ laser, and both motor evoked and somatosensory evoked potentials can be helpful during the removal of such lipomas.

Nondysraphic cervicomedullary intramedullary lipoma

Spinal cord lipomas are usually associated with spinal dysraphism and is most common in lumbosacral region. Spinal intradural lipoma is a rare condition accounting for less than 1% of spinal cord tumours and is most prevalent in cervicodorsal region. Intramedullary spinal cord lipoma of cervical spine not associated with spinal dysraphism is one of the rarest lesions. They usually present insidiously with slowly progressive myelopathic deficits. We present a case of nondysraphic intramedullary spinal cord lipoma with exophytic component and intracranial extension. A 30 year male patient presented with wasting of muscles of left shoulder and left forearm with resultant weakness for last two months and myelopathic signs. Magnetic resonance imaging revealed a T1 hyperintense , T2 hypointense lesion on the dorsal aspect of cervical spinal cord with intracranial extension and exophytic component. There was no contrast enhancement, fat suppression image indicated a lipoma. The patient underwent cervical laminectomy with foramen magnum decompression with subtotal resection of intramedullary lipoma. Histopathology examination confirmed the diagnosis of lipoma. Subtotal resection of intramedullary lipoma is a reasonable and acceptable surgical option considering the benign nature of lesion and high probability of neurological deterioration due to dense adhesion between lipoma and neural tissue.

Massive bilocular spinal cord intramedullary lipoma of the thoracic spine

Spinal cord intramedullary lipomas are rare, comprising 2% of intramedullary tumours. They are more often associated with spinal dysraphism, while lipomas not associated with spinal dysraphism are even less frequent, accounting for 1% of cases. The pathogenesis of spinal cord intramedullary lipomas remains unclear. MRI is the gold standard for the evaluation of these lesions. We hereby present a case of a 37-year-old male, who underwent MRI due to spastic paraparesis. MRI revealed a bilocular, spinal cord intramedullary lesion at the level of T ₂-T ₅, with dilatation of the spinal canal and signal characteristics compatible with lipoma. There was no clear imaging evidence of spinal dysraphism. The patient underwent surgery and diagnosis was confirmed histopathologically.

Long term outcome of non-dysraphic intramedullary spinal cord lipomas in adults: case series and review

STUDY DESIGN

It is a case series involving clinical presentation, radiological findings, surgical technique and long term outcome of Non-dysraphic intramedullary spinal cord lipomas in adults along with the review of the literature.

PURPOSE

The purpose of the study is to find out from our series as well as from literature what determines the long term outcome and how it can be improved in patients diagnosed to have intramedullary spinal cord lipomas.

OVERVIEW OF LITERATURE

Non-dysraphic spinal intramedullary lipomas in adults are extremely rare. Majority of cases occur in children and in cervico-dorsal regions. Only eight cases of dorso-lumbar spinal lipomas without spinal dysraphism in adults have been reported in the English literature till 2013.

METHODS

Here we report our experience with three such cases in the dorsolumbar region and discuss the surgical technique and the long term outcome of such cases.

RESULTS

Review of literature and from our own cases we conclude that long term outcome after surgery is determined by the preoperative neurological status.

CONCLUSIONS

Earlier surgical intervention with preserved neurological status results in better outcome. Radical subtotal excision without producing iatrogenic postoperative neurological deficit should be the goal of the surgery and it stabilizes the disease process in the long run. When early clinico-radiological signs of recurrence develop, such patient's to be reoperated immediately to prevent them from developing a fixed neurological deficit.

Intraspinal lipomas without associated spinal dysraphism

Introduction:

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.

Successful surgical excision of a nondysraphic holodorsal intramedullary lipoma in a 14-month-old child

INTRODUCTION

Nondysraphic intramedullary lipomas of the spinal cord are rare lesions. They are most commonly seen in the second or third decade of life. Their occurrence in the pediatric age group is even rarer.

CASE REPORT

The authors describe a 14-month-old child who presented with delayed motor milestones involving the bilateral lower limbs. The child was unable to sit or stand. MRI revealed a dorsally located intramedullary lipoma extending from C7 to D12. The child underwent C7-L1 laminotomy and gross total excision of the lipoma. Postoperatively, the child improved neurologically and attained normal power in the bilateral lower limbs.

DISCUSSION

Very few cases of extensive intramedullary lipomas involving the dorsal cord have previously been reported. Only two cases of pediatric extensive dorsal lipomas have been mentioned to date. The authors describe successful surgical excision of a holodorsal intramedullary lipoma in a 14-month-old child. To the best of the authors' knowledge, this is the first case being reported of a holodorsal intramedullary lipoma in the youngest patient.

Non-dysraphic intradural spinal cord lipoma: case series, literature review and guidelines for management

PURPOSE

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.

METHODS

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.

RESULTS

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.

CONCLUSION

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.

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.

Nondysraphic cervical and thoracic intraspinal lipomas: a review

BACKGROUND

Intraspinal lipomas are commonly seen in the lumbosacral area. A cervical and thoracic location is very rarely encountered. Management of these lesions is still controversial.

METHOD

We report a series of 8 such patients, who were surgically managed at our institute.

FINDINGS

All the patients were adults (mean age-34 years). Subcutaneous lipomas were seen in two patients. None of the 8 patients were obese. Mean duration of symptoms was 484 days. The Nurick's grade at the time of presentation ranged from 3 to 5. All 8 patients underwent partial decompression. Only 1 patient required repeat surgery after 11 years. All the patients reported improvement or stabilization of symptoms at follow-up (mean 56.3 months). The Nurick's grading at the time of follow-up ranged from 1 to 4.

CONCLUSION

A cervical or thoracic location is extremely rare among intraspinal lipomas. Patients usually present with a long duration of symptoms. Complete excision is extremely difficult and likely to be detrimental. Partial decompression usually leads to good improvement.

Surgical treatment of spinal lipoma without spina bifida at lumbar region-three case reports-

Three men aged 40 to 60 years presented with rare lumbar spinal intradural lipomas without spina bifida manifesting as worsening numbness, pain of the lower extremities, and bladder dysfunction. All 3 patients underwent decompressive laminectomy. The lipoma and cauda equina nerves were dissected from the dura mater under the operating microscope, untethering the spinal cord and returning the cauda equina nerves to the original position. Duralplasty was performed using an expanded polytetrafluoroethylene sheet. Postoperatively, all patients experienced improvement of their neurological deficits. In the surgical treatment of spinal lipomas, the primary purpose is untethering and decompression, which can be achieved by untethering the spinal cord, returning the cauda equina nerves to the normal position, laminectomy, and duralplasty, without removal of the lipoma.

Cervicobulbar intramedullary lipoma

BACKGROUND CONTEXT

Spinal lipomas not associated with spinal dysraphism are rare entities. Further, large medullary lipomas with intracranial extension are occasionally described. Most of the intradural lipomas are subpial and not really intramedullary.

PURPOSE

Clinicians may be made aware of such a rare entity and its presentation.

STUDY DESIGN/SETTING

An extremely rare case of medullary lipoma extending into posterior fossa is described in an adult, not associated with spinal dysraphism.

METHODS

A young male presented with high cord myelopathy in the form of spastic quadriparesis. Radiological investigations revealed dorsally placed intramedullary lipoma extending into posterior fossa.

RESULTS

Surgical excision of tumor provided satisfactory resolution of symptoms.

CONCLUSIONS

Medullary lipomas may present with features of high cord compression and myelopathy. Magnetic resonance imaging remains the investigative and follow-up modality of choice. Even when total tumor excision is not feasible, subtotal removal and decompression provides long lasting symptom-free survival.

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

BACKGROUND

Spinal intramedullary lipoma extending to the posterior fossa is very rare in children. We made a revision of the literature and report the diverse opinions and surgical procedures.

CASE DESCRIPTION

We report the case of a 16-month-old male infant who was operated on in the Pediatric Neurosurgical Unit of our hospital; his clinical and surgical outcome are related.

CONCLUSION

Intramedullary lipoma of the spinal cord with intracranial extension in infancy is a very rare pathology reported in the literature. Our patient was treated with decompression and subtotal removal; he had a critical postoperative course but was recovering slowly after that. Most authors prefer incomplete resection because these lesions do not have a clear-cut margin. Another neurosurgeon performed a decompression only, without resection. Some authors performed the surgical treatment before symptom progression. Another surgeon reported that the surgical indication is debatable when the neurologic manifestations are poor or absent. The surgical indication and the strategy for treatment are controversial and they depend on the clinical situations of the patients.

Intramedullary spinal epidermoid associated with an intramedullary lipoma

True intramedullary epidermoids and true intramedullary lipomas of the spinal cord are very rare lesions. To our knowledge, there has been no reported case associated with an intramedullary spinal lipoma. This is the first reported case with the association of these two lesions. In this report a 3-year-old boy with intramedullary spinal lipoma is presented. We discuss the frequency, clinical features, MRI characteristics and limits of surgical treatment of these tumors and review the associated literature.

Intradural cervical lipoma with parenchymal marginal fibrous tissue: case report

OBJECTIVE

The author reports an intradural cervical subpial lipoma with parenchymal marginal fibrous tissue causing neurological deterioration.

METHODS

Computed tomographic and magnetic resonance imaging scans revealed the lesion. Magnetic resonance imaging fat suppression was an especially useful tool for diagnosis.

RESULTS

The gross appearance and microscopic findings implied that this tumor had a progressive character. A subtotal resection was carried out and pathological studies confirmed the diagnosis.

CONCLUSION

Postoperatively, the patient made an excellent recovery.

Intramedullary lipoma of the cervicodorsal spinal cord with intracranial extension: case report

BACKGROUND

An unusual case of an extensive intramedullary lipoma of the cervicodorsal spinal cord with intracranial extension causing compression of spinal cord and brainstem is described.

CASE DESCRIPTION

A 3-year-old child with lack of limb movement since birth, the cause of which had remained obscure, developed opisthotonos and episodes of severe respiratory difficulty with brief periods of apnea. Craniospinal computed tomography and magnetic resonance imaging (MRI) were diagnostic of lipoma. Urgent occipitocervical decompression and subtotal removal of the posterior fossa and cervical spinal cord lipoma resulted in lasting resolution of symptoms.

CONCLUSIONS

Extensive spinal cord lipomas with intracranial extension can present with alarming spinal cord/medullary compression and respiratory symptoms. Computed tomographic scan and MRI are diagnostic. Total removal is not feasible, or necessary, because subtotal removal and decompression give long-lasting resolution of symptoms.

Nondysraphic intramedullary spinal cord lipomas: a review

OBJECT

Lipomas of the spinal cord are often a component of spinal dysraphic states. Nondysraphic intramedullary spinal cord lipomas are rare, and their presentation, in the form of gradually worsening myelopathy, is nonspecific. The authors report on the methods used for diagnosis and treatment in patients presenting with these lesions at their institution, and they review the relevant literature.

METHODS

The authors treated 14 patients who presented with intramedullary lipomas over a period of 12 years. None of these patients had segmentation anomaly or dysraphism of the spine, or any hindbrain anomaly. Admission magnetic resonance images were diagnostic in all patients. All tumors were located dorsally in the spinal cord, the majority of them in the cervicodorsal cord. The lipomas were partially excised with the help of a carbon dioxide laser in all patients in an attempt to preserve neurological function. All patients attained improvement in their sensory and motor symptoms.

CONCLUSIONS

Because these lesions do not have a clear-cut margin, it is vital to preserve neurological function at the time of surgery, even if it entails incomplete resection.

An infant with an intradural lipoma of the cervical spine extending into the posterior fossa

BACKGROUND

Intradural lipomas of the cervical spine are very rare. These tumours show no association with spinal dysraphism. We describe an infant with cervical spinal cord lipoma. Surgical decompression of the cord resolved all neurologic deficits.

CASE DESCRIPTION

An 8 month old female infant presented with retarded development of motor function in the limbs, in addition to dysphagia. Computed tomography identified a tumour of fat density that extended from the medulla to C7. Magnetic resonance imaging showed hyperintensity on both T1- and T2-weighted images. A fat-suppression sequence demonstrated an area of signal enhancement in the dorsal portion of the tumour following administration of gadolinium. The adjacent spinal cord was normal. Partial removal of the tumour was performed together with decompressive laminoplasty. The enhancing region proved to be fibrous tissue. Motor development resumed in the week following operation.

CONCLUSION

Retarded motor development was the main manifestation of this infant's rare spinal tumour. Neuroimaging was of considerable diagnostic value; in particular, fat-suppression magnetic resonance imaging demonstrated details of the tumour and surrounding structures. Decompressive laminoplasty and laminectomy with partial removal of the tumour was effective in reversing clinical deficits.

High cervical lipoma: A case report and review with classification

We experienced a 51 year-old female with high cervical lipoma who complained of neck pain and hypoaesthesia on her right lower extremity. She underwent surgery for removal of the tumour, but she was found unconscious after the surgery and then died after 19 days.

Intramedullary holocord lipoma in an athlete: case report

OBJECTIVE AND IMPORTANCE

Holocord intradural lipoma extending from the cervical to the lumbar spine is an exceedingly rare condition. An extensive review of the literature revealed that only eight other cases have been reported, and none occurred during the contemporary magnetic resonance imaging era.

CLINICAL PRESENTATION

A case of holocord intradural lipoma that was partially resected with the aid of carbon dioxide laser and intraoperative ultrasound is reported.

TECHNIQUE

The intimate relationship of the lipoma to the nerve roots and the absence of a distinct plane between tumor and spinal cord precluded a complete resection of this tumor. At 7 months postoperatively, the patient's dysesthetic pain had resolved almost completely. Proprioception in the lower extremities had improved significantly to the point that the patient was able to walk without a cane and his preoperative Romberg's sign had disappeared.

CONCLUSION

Extensive intradural intramedullary spinal lipomas can present in adulthood with symptoms of myelopathy as well as nonradicular pain. We encourage early surgical debulking of the tumor to prevent further progression of symptoms and to offer the possibility of neurological improvement.

Dorsal brain stem lipomas: case report

Intracranial lipomas are uncommon and rarely symptomatic lesions accounting for 0.06 to 0.46% of intracranial lesions. The management of symptomatic dorsal brain stem lipomas was once limited to cerebrospinal fluid diversion, but with recent advances in microsurgery, they now may be directly treated. We report three patients with dorsal brain stem lipomas, two of which involved the quadrigeminal cistern and one of which was in the cisterna magna region. Antenatal documentation by ultrasound examination in one patient represents the first reported in utero diagnosis of quadrigeminal cistern lipoma. Computed tomographic and magnetic resonance imaging scans were diagnostic. The surgical experience in two symptomatic patients is discussed. Microsurgical decompression was performed in each without neurological deficit, and clinical symptoms postoperatively subsided. No patient required a permanent cerebrospinal fluid shunt. The management of symptomatic dorsal brain stem lipomas is discussed, and an algorithm is proposed.

Cervical intramedullary lipoma with unusual MRI features: case report

Intramedullary (subpial) lipomas not associated with spinal dysraphism are very unusual [1]. A confident preoperative diagnosis is usually possible with MRI. We present a case of an isolated cervical intramedullary lipoma with unusual imaging morphology and imaging characteristics (distinctly low-signal on T2-weighted images) on MRI. An explanation for these features is proposed.

Intradural spinal lipomas not associated with spinal dysraphism: a report of four cases

Intradural spinal lipomas that are not associated with spinal dysraphism are rare. We report four cases of adult patients with intradural spinal lipomas. All of the patients were young adults, three women and one man, who ranged in age from 22 to 37 years (mean, 30.3 yr). The clinical presentation of these lesions varied, depending upon the size and location of each lipoma. It is interesting that the symptoms in the women gradually deteriorated during pregnancy or after delivery. Magnetic resonance imaging was very useful in determining the exact location of lipoma. In three of four patients, neurological improvement was obtained after decompressive laminectomy and partial removal of the lipoma.

Intramedullary spinal cord lipomas

Spinal cord lipomas are rare lesions, accounting for approximately 1% of all spinal cord tumors. True intramedullary spinal cord lipomas are extremely rare and are represented in the literature as scattered, single case reports. The authors present a series of six patients with intramedullary spinal cord lipomas managed at our institution from July, 1985 to July, 1993. The patients' ages ranged from 8 to 45 years. Four patients presented with newly diagnosed tumors and two had undergone previous surgery. Patients usually presented with long histories of disability followed by rapid progression of their symptoms. Most patients were in poor neurological condition on presentation. Presenting symptoms included spinal pain, dysesthetic sensory changes, gait difficulties, weakness, and incontinence. Three patients had cervical tumors, two had cervicothoracic tumors, and one patient had a thoracic tumor. Diagnostic studies, including magnetic resonance imaging, were obtained in all patients. No patient exhibited any form of spinal dysraphism or had a dural defect. All patients underwent decompressive, subtotal resections of 40% to 70% of their lesions. Follow-up times ranged from 12 to 96 months. All patients had resolution of their pain, but they generally showed no neurological improvement. As of their most recent follow-up visit, none of the patients was neurologically normal; three can function independently, although with neurological deficits. The other three patients cannot function independently and have severe neurological deficits. The authors conclude that patients with intramedullary spinal cord lipoma who present with significant neurological compromise have a very poor prognosis with regard to neurological function and generally show no improvement with surgical resection.

Congenital intramedullary lipoma of the dorsocervical spinal cord with intracranial extension: case report

The unusual computed tomographic findings of an extensive intramedullary lipoma of the dorsocervical spinal cord, which extended into the brain stem, in a 9-month-old infant are described and correlated with the surgical findings. The operative therapeutic options are discussed.

Extensive cervical intradural and intramedullary lipoma and spina bifida occulta of C1: a case report

A 17-year-old boy presented with a 1-year history of progressive gait difficulties and slowing of fine hand movements. On neurological examination there was tetraspasticity, bilateral pes equinovarus and a decreased position sense in the feet. CT and MRI scan of the cervical spine demonstrated a spina bifida occulta of C1, an extensive intradural lipoma from the foramen magnum to C4 with a small intramedullary portion at C3, and a distal syringomyelia reaching down to D12. After excision of the extramedullary portion of the lipoma, there was a marked improvement of the gait and a reduction of the spasticity.

Cervical intraspinal lipoma in a pregnant patient

Tetraparesis developing in a female, during pregnancy, was found to be due to an intradural cervical lipoma, associated with a subcutaneous lipoma at the same level in the midline posteriorly. Sub-total removal produced a return to near normal function with the patient being fully ambulant 7 months later.

Intracranial lipomas: current perspectives in their diagnosis and treatment

Intracranial lipomas are very rare lesions, which are probably congenital. Though they can occur anywhere in the intracranial space, a high proportion of cases tend to be ++located around the midline. They are usually asymptomatic. When symptoms do occur, they are frequently the result of co-existing general clinical conditions. Lipomas used to be reported mainly as incidental findings at autopsy, but advances in neuroimaging techniques have greatly improved the likelihood of their being discovered during life. Surgical extirpation is not necessary in the majority of patients, many of whom show remarkable clinical improvement following shunt procedures for obstructive hydrocephalus (when present) as well as vigorous treatment of co-existing conditions.

Intracranial lipomas

Intracranial lipomas are very rare, probably congenital lesions. Though they can occur anywhere in the intracranial space, a good proportion of cases tend to be located around the midline. Review of the literature as well as our own three cases--which forms the basis of this article--shows that they are mostly asymptomatic. When symptoms occur, they are frequently the result of coexisting general clinical conditions. Lipomas used to be reported mainly as incidental findings at autopsy. Advances in neuro-imaging techniques have vastly improved the likelihood of their being discovered during life. At present however, significant increase in the reported incidence of these tumours is yet to be seen. Surgical extirpation of the tumour is not considered necessary in the majority of patients, many of whom show remarkable clinical improvement following shunt procedures for obstructive hydrocephalus as well as treatment of coexisting conditions such as epilepsy.

Magnetic resonance imaging of a high cervical intradural lipoma

A case of intradural spinal lipoma, rarely seen in the high cervical region, is described. Extension into the posterior fossa is not infrequent with these rare tumors. Magnetic resonance imaging clearly showed the longitudinal dimension of the tumor as well as the infiltrative extension into the spinal cord without any invasive procedure.

Long-term results of surgical treatment of spinal lipomas. Report of 18 cases

We report the long-term results of surgery on spinal lipomas in a series of 18 patients. Four patients had congenital lipomas with spina bifida and/or myelomeningocele and the other fourteen had tumoural (true) lipomas. Simple decompression or subtotal removal afforded a very good prognosis in all patients with intradural lipomas whose preoperative neurological deficits were slight. In the light of the long follow-up, the lack of difference in biological behaviour between congenital and tumoural (true) lipomas leads us to regard the two types as a single maldevelopment entity of dysembryogenetic origin.

Subdural spinal lipoma with posterior fossa extension

A case is described of subdural spinal lipoma with posterior fossa extension and the world literature is reviewed. A high proportion of high cervical lipomas extend into the posterior cranial fossa. Many cases were probably missed in the pre-computed tomography era. Those cases with posterior fossa growth are more likely to be found in infants or those cases with symptoms dating from birth; most present with quadriparesis. All cases of high cervical lipoma demonstrated by myelography should be submitted to brain computed tomography in order to exclude posterior fossa extension and demonstrate the presence of hydrocephalus.