Intraspinal lipomas without associated spinal dysraphism

Nondysraphic Intramedullary Lipoma of the Cervical Spine: A Systematic Review of Management Strategies and Outcomes

BACKGROUND

Nondysraphic intramedullary lipomas of the cervical spine are extremely rare, and only a few cases have been reported. We aimed to provide a thorough review of the literature regarding patient characteristics, treatment options, and outcomes in these patients. We also provided an illustrative case from our institution, which we added to the pool of patients identified by our review.

METHODS

Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, the literature in PubMed/Medline, Web of Science, and Scopus databases was searched. Nineteen studies were included in the final quantitative analysis. The Joanna Briggs Institute critical appraisal tool was used to assess the risk of bias.

RESULTS

We identified 24 patients with nondysraphic cervical intradural intramedullary lipoma of the spinal cord. The patients were predominantly male (70.8%) with a mean age of 30.3 years. Quadriparesis was observed in 33.3% of the cases, while paraparesis occurred in 25% of the patients. Sensory disturbances were observed in 8.3% of the cases. In some patients, the presenting symptoms were neck pain (4.2%) and headache (4.2%). Surgical treatment was performed in 22 cases (91.7%). In 13 cases (54.2%) a subtotal removal was reached, and in 8 cases (33.3%) partial tumor removal was feasible. In 1 case (4.2%) a simple laminectomy was performed. Fourteen patients (58.3%) improved, 6 (25%) were unvaried, and 2 (8.3%) worsened. The mean follow-up was 30.8 months.

CONCLUSIONS

Overall, surgical treatment can provide substantial spinal cord decompression improving or stabilizing the neurologic deficits. Experience from our case, along with analysis of reports from the literature, suggests that careful and controlled resection may provide benefits and avoid serious complications otherwise that result from aggressive resection.

Surgical management of spinal "Subpial" lipomas

BACKGROUND

This study reports five cases of subpial lipomas via a new grouping method with respect to the cases' distinctive magnetic resonance imaging characteristics to provide insight into the management of this entity.

METHOD

From January 2013 to December 2014, five cases of pathologically diagnosed subpial lipomas that received surgical treatment in our department were included. The clinical histories and medical records were carefully reviewed, and the radiological characteristics were periodically inspected after surgery. The preoperative radiology and symptoms were reviewed with regard to outcome.

RESULTS

All five patients were confirmed as having lipomas based on their histological results. Total removal was achieved in one patient only, with partial removal in the other four patients. Neurological deterioration was observed in all patients immediately after surgery, with a typically lower McCormick score. Two of the patients returned to preoperative level one year later. Based on radiological traits, the lipomas could be divided into "simple" and "invasive." The syrinx formation and neurological recovery were different between these two kinds of lipoma.

CONCLUSION

Surgery for subpial lipomas without dysraphisms is frequently accompanied by neurological deterioration, temporally or permanently. Thus, this new classification of subpial lipomas into "simple" and "invasive" based on radiological traits may be valuable for making better surgical decisions.

Surgical strategies and outcomes for intradural lipomas over the past 20 years

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.