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Karki S, Regmi P, Parajuli A, Kumari K, Thapa B, Shilpakar SK. Nondysraphic intramedullary spinal cord lipoma: a case report. Ann Med Surg (Lond) 2024; 86:3683-3689. [PMID: 38846861 PMCID: PMC11152800 DOI: 10.1097/ms9.0000000000002060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 04/02/2024] [Indexed: 06/09/2024] Open
Abstract
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 The authors report a rare case of a 35-year-old male who presented with progressive difficulty in walking for 6 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.
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Affiliation(s)
| | - Prakash Regmi
- Department of Neurosurgery, Tribhuvan University Institute of Medicine, Maharajgunj, Nepal
| | | | | | - Bikas Thapa
- Department of Neurosurgery, Tribhuvan University Institute of Medicine, Maharajgunj, Nepal
| | - Sushil K. Shilpakar
- Department of Neurosurgery, Tribhuvan University Institute of Medicine, Maharajgunj, Nepal
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Adhimarta W, Islam AA, Kurniawan VR, Otniel J, Faruk M. Adult cervicothoracic subpial fibrolipoma without dysraphism: An extremely rare case report. Int J Surg Case Rep 2023; 109:108616. [PMID: 37544094 PMCID: PMC10423883 DOI: 10.1016/j.ijscr.2023.108616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/29/2023] [Accepted: 07/31/2023] [Indexed: 08/08/2023] Open
Abstract
INTRODUCTION Spinal tumors constitute 15 % of all tumors in the central nervous system. Pain is often the initial symptom, which can be localized, nocturnal, or radiated to the arms and/or limbs. We report a rare case with a subpial lipoma in the cervicothoracic spine and review the current literature. CASE PRESENTATION A 22-year-old female presented with the chief complaint of tetraparesis for three months before admission. Magnetic resonance imaging revealed an intradural tumor on the fifth cervical to fourth thoracic vertebrae. She underwent a laminectomy to remove the tumor completely. Histopathological examination revealed a proliferation of mature fat cells amongst fibrous connective tissue. Surrounding nerve fibers and erythrocyte-filled blood vessels were also found, suggesting a subpial fibrolipoma. Postoperatively, there was an improvement in muscle strength six weeks after surgery. Motoric strength was grade 5 for the upper extremities and grade 4 for the lower extremities. DISCUSSION In this patient, cervicothoracic laminectomy and tumor removal were performed without instrumentation. Total tumor resection is the primary goal when removing a pathological lesion. However, this depends on the lesion's adhesion to the surrounding tissue. Therefore, partial tumor resection may be possible, given the neurological complications that can occur. CONCLUSION Because subpial lipomas are rare, their treatment is highly specialized. An assessment of the patient's physical condition and imaging assessments can provide information about potential treatment strategies and outcomes.
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Affiliation(s)
- Willy Adhimarta
- Department of Neurosurgery, Faculty of Medicine, Universitas Hasanuddin, Makassar, Indonesia
| | - Andi Asadul Islam
- Department of Neurosurgery, Faculty of Medicine, Universitas Hasanuddin, Makassar, Indonesia
| | | | - James Otniel
- Department of Neurosurgery, Faculty of Medicine, Universitas Hasanuddin, Makassar, Indonesia
| | - Muhammad Faruk
- Department of Surgery, Faculty of Medicine, Universitas Hasanuddin, Makassar, Indonesia.
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Moreno Gómez LM, García-Pérez D, González-León PJ, Munarriz PM, Castaño-León AM. Pathogenesis of spinal intramedullary lipomas: two case reports. J Med Case Rep 2023; 17:317. [PMID: 37488574 PMCID: PMC10367250 DOI: 10.1186/s13256-023-04048-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 06/19/2023] [Indexed: 07/26/2023] Open
Abstract
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.
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Affiliation(s)
- Luis Miguel Moreno Gómez
- Neurosurgery Department, University Hospital "12 de Octubre", Avda de Córdoba, s/n, 28041, Madrid, Spain.
| | - Daniel García-Pérez
- Neurosurgery Department, University Hospital "12 de Octubre", Avda de Córdoba, s/n, 28041, Madrid, Spain
| | - Pedro Juan González-León
- Neurosurgery Department, University Hospital "12 de Octubre", Avda de Córdoba, s/n, 28041, Madrid, Spain
| | - Pablo M Munarriz
- Neurosurgery Department, University Hospital "12 de Octubre", Avda de Córdoba, s/n, 28041, Madrid, Spain
| | - Ana María Castaño-León
- Neurosurgery Department, University Hospital "12 de Octubre", Avda de Córdoba, s/n, 28041, Madrid, Spain
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Unusual presentation of a giant thoracic spinal cord lipoma. Spinal Cord Ser Cases 2022; 8:35. [PMID: 35347111 PMCID: PMC8960759 DOI: 10.1038/s41394-022-00489-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 01/26/2022] [Accepted: 01/28/2022] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Non-dysraphic intradural spinal cord lipomas are rare, and true intramedullary cervical-thoracic lipomas are extremely rare. Spinal lipomas usually present with chronic, progressive myelopathic features. Unlike dysraphic lipomas, which are usually located in the lumbo-sacral region, non-dysraphic lipomas are usually located in the cervical or thoracic spine. CASE PRESENTATION We present an unusual case of a 21-year-old female who presented with four months of severe back pain, progressive spasticity, and weakness in the lower limbs. Magnetic resonance imaging (MRI) revealed a T1- and T2-hyperintense lesion between D4 and D6. DISCUSSION This fatty intramedullary lesion had undergone evolution and a possible hemorrhagic infarct and cord compression. The patient underwent an urgent dorsal laminoplasty and total resection of this lesion, which histopathology indicated was a fibrous lipoma. Total resection is possible in such cases if a micro-surgical technique that includes neurophysiological monitoring is used.
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Gupta A, Bansal K, Kalidindi KKV, Bhargava A, Verma A. Intradural Conus Medullaris Lipoma With Neurological Deficit: A Rare Occurrence. Cureus 2021; 13:e14053. [PMID: 33898137 PMCID: PMC8059682 DOI: 10.7759/cureus.14053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Intradural lipoma without spinal dysraphism is a rare occurrence. Most of them are asymptomatic but can also present with neurological deficits. A 54-year-old male patient presented to us with progressive weakness in both lower limbs for six months. On physical examination and radiological workup, intradural lipoma was diagnosed. Due to progressive neurological deficit, the patient was treated surgically. On 2.5 years of follow-up, the patient showed complete neurological recovery. Intradural lipomas can also present with the neurological deficit at any age and should be managed surgically if the deficit is progressive in nature. Surgical management has a good outcome if done within two years of onset of symptoms.
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Affiliation(s)
- Anuj Gupta
- Department of Orthopedics and Spine, Max Super Speciality Hospital, New Delhi, IND
| | - Kuldeep Bansal
- Department of Spine Services, Indian Spinal Injuries Center, New Delhi, IND
| | | | - Aayush Bhargava
- Department of Orthopedics, University College of Medical Sciences, Guru Teg Bahadur Hospital, New Delhi, IND
| | - Aditya Verma
- Department of Orthopedics, Indian Spinal Injuries Center, New Delhi, IND
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Ikeda N, Odate S, Shikata J, Yamamura S, Kawaguchi S. Surgical strategies and outcomes for intradural lipomas over the past 20 years. J Clin Neurosci 2018; 60:107-111. [PMID: 30327217 DOI: 10.1016/j.jocn.2018.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 10/04/2018] [Indexed: 10/28/2022]
Abstract
Intradural lipoma is an extremely rare spinal tumor. The boundary between the spinal cord and the lipoma is usually unclear, with adhesions being firm. Thus, total resection of the tumor is difficult and the neurological prognosis after total resection is poor. Information on the management of this type of tumor is scarce owing to the limited studies that have been conducted and the low sample sizes reported. Here, we report a case and provide a review of the literature on intradural lipomas over the past 20 years. In addition to describing our case, we reviewed reports published in Pubmed and CiNii. The demographic data of the patients included in these studies were extracted and the surgical procedures were assessed, along with their corresponding postoperative outcomes. There were 57 primary cases and 4 cases of recurrence. Among the primary cases, the neurological symptoms were persistent in 54 (95%) after surgery. The postoperative outcomes after excessive (>60% tumor resection) or total resection were significantly poor. In the recurrence cases, the mean period from initial surgery to recurrence was 11 years and all initial surgical procedures involved only partial resection surgery. This report is, to the best of our knowledge, the most exhaustive analysis of cases of intradural lipomas and recurrences. The optimal treatment for lipoma necessitates both partial resection and duraplasty.
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Affiliation(s)
- Norimasa Ikeda
- Department of Orthopaedic Surgery, Spine Center, Gakkentoshi Hospital, 7-4-1 Seikacho, Seikadai, Sorakugun, Kyoto, Japan.
| | - Seiichi Odate
- Department of Orthopaedic Surgery, Spine Center, Gakkentoshi Hospital, 7-4-1 Seikacho, Seikadai, Sorakugun, Kyoto, Japan
| | - Jitsuhiko Shikata
- Department of Orthopaedic Surgery, Spine Center, Gakkentoshi Hospital, 7-4-1 Seikacho, Seikadai, Sorakugun, Kyoto, Japan.
| | - Satoru Yamamura
- Department of Orthopaedic Surgery, Spine Center, Gakkentoshi Hospital, 7-4-1 Seikacho, Seikadai, Sorakugun, Kyoto, Japan
| | - Shinji Kawaguchi
- Department of Orthopaedic Surgery, Spine Center, Gakkentoshi Hospital, 7-4-1 Seikacho, Seikadai, Sorakugun, Kyoto, Japan
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Pasalic I, Brgic K, Nemir J, Kolenc D, Njiric N, Mrak G. Intramedullary Spinal Cord Lipoma Mimicking a Late Subacute Hematoma. Asian J Neurosurg 2018; 13:1282-1284. [PMID: 30459918 PMCID: PMC6208254 DOI: 10.4103/ajns.ajns_112_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Spinal cord lipomas are rare and benign tumors which may cause progressive neurological deficits due to their local expansion. We present the case of a 59-year-old male patient with severe lumbosacral pain and slowly progressive paresis of the right leg, misdiagnosed with degenerative spine disease. Repeated magnetic resonance (MR) T1-weighted images of the thoracic spine suggested a subacute intramedullary hematoma. Due to progression of the neurological deficit, the patient was referred to a neurosurgeon, who indicated surgical evacuation of the hematoma. The intraoperative finding revealed an intramedullary spinal cord lipoma, which was later confirmed by histological analysis. Since subacute intramedullary hematomas and intramedullary spinal cord lipomas present with similar clinical and radiological features, diffusion-weighted MR imaging should be used to distinguish these entities.
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Affiliation(s)
- Ivan Pasalic
- Department of Neurosurgery, University Hospital Center Zagreb, University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Klara Brgic
- Department of Neurosurgery, University Hospital Center Zagreb, University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Jakob Nemir
- Department of Neurosurgery, University Hospital Center Zagreb, University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Danijela Kolenc
- Department of Neuropathology, University Hospital Center Zagreb, University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Niko Njiric
- Department of Neurosurgery, University Hospital Center Zagreb, University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Goran Mrak
- Department of Neurosurgery, University Hospital Center Zagreb, University of Zagreb, School of Medicine, Zagreb, Croatia
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Organji H, Rajabkhah S, Fatehi F. A giant cervicothoracic cord lipoma: an uncommon finding. Acta Neurol Belg 2017; 117:541-543. [PMID: 27670441 DOI: 10.1007/s13760-016-0700-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Accepted: 09/20/2016] [Indexed: 10/20/2022]
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