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LETTER TO EDITOR
Year : 2009  |  Volume : 4  |  Issue : 1  |  Page : 55-56
 

Nondysraphic intradural spinal lipoma


1 Institute of Pathology, ICMR, New Delhi, India
2 Department of Neurosurgery, Sadarjung Hospital, New Delhi, India

Correspondence Address:
Avninder Singh
Institute of Pathology-ICMR, Sadarjung Hospital Campus, New Delhi-110 029
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1817-1745.49116

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How to cite this article:
Singh A, Gupta V, Singh H, Chand K. Nondysraphic intradural spinal lipoma. J Pediatr Neurosci 2009;4:55-6

How to cite this URL:
Singh A, Gupta V, Singh H, Chand K. Nondysraphic intradural spinal lipoma. J Pediatr Neurosci [serial online] 2009 [cited 2019 Oct 16];4:55-6. Available from: http://www.pediatricneurosciences.com/text.asp?2009/4/1/55/49116


Sir,

A 12 year-old girl presented with progressive weakness of both lower limbs, difficulty in walking, and numbness in her legs since the last two months. She had become bedridden for the last one week. Clinical examination did not reveal any stigmata such as dimples, hair, fistulae, or any mass on her spine. Neurological examination showed spastic paraplegia with 0/5 grade bilateral power. All sensations were markedly diminished below the D5 level. MRI scans revealed a hyperintense, elongated mass lesion on the saggital T1W and T2W images between the D3-D8 segments [Figure 1]. Axial T1W image showed that the lipoma was situated dorsal to the spinal cord [Figure 2]. A D3-D8 laminectomy was done and the duramater was opened in the midline and retracted. A lipoma was identified on the posterior aspect of the cord and there was no clear surgical cleavage between the cord and the tumor. Subtotal excision was carried out. No significant improvement was seen in the neurological status at the six months' follow-up and the patient was referred for physiotherapy and rehabilitation. However, the patient was lost to follow-up subsequently.

Intradural spinal lipoma (ISL) constitutes approximately 1% of all spinal tumors and is usually associated with lumbo-sacral spinal dysraphism. [1] ISLs unassociated with spinal dysraphism are rare with only a few cases being reported in literature. [2],[3],[4],[5],[6] They are seen in children and young adults and are situated on the posterior aspect of the spinal cord in the cervico-thoracic or thoracic regions. They show equal gender incidence but are reported to show aggravation of symptoms during or after pregnancy. [3] The patients usually present with a long history of disability followed by a rapid progress of symptoms. The presenting complaints are spastic weakness in the extremities, dysestheic sensory changes, and gait difficulties. The neurological deficits are initially subtle and the history can span many years before the patient seeks medical attention. Theories about their pathogenesis are controversial, but the malformation theory wherein inclusion of the misplaced adipocytes during the formation of the neural tube causes the growth of lipoma . Thus, this is a hamartoma rather than a true neoplasm, which also explains the dorsal location of the lipoma. [3] Some believe intraspinal lipomas are congenital lesions and would not only compress, but also replace normal tissue during development. [6] A spinal lipoma without dysraphism has only a small space for expansion and thus, has an early presentation of symptoms as seen in our case.

ISLs adhere so closely to the adjacent spinal cord that they cannot be excised completely. Most symptomatic patients do not show any significant improvement in the neurological function after surgery. Hence, the operative principle should be decompression before symptom progression and subtotal resection wherever necessary.

 
   References Top

1.Giuffre R. Intradural spinal lipomas: Review of the literature (99 cases) and report of an additional case. Acta Neurochir 1966;14:69-95.  Back to cited text no. 1    
2.Ammerman BJ, Henry JM, De Girolami U, Earle KM. Intradural lipomas of the spinal cord: A clinicopathological correlation. J Neurosurg 1976;44:331-6.  Back to cited text no. 2  [PUBMED]  
3.Fujiwara F, Tamaki N, Nagashima T, Nakamura M. Intradural spinal lipomas not associated with spinal dysraphism: A report of four cases. Neurosurgery 1995;37:1212-5.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]
4.Kim CH, Wang KC, Kim SK, Chung YN, Choi YL, Chi JG, et al. Spinal intramedullary lipoma: Report of three cases. Spinal Cord 2003;41:310-5.  Back to cited text no. 4  [PUBMED]  [FULLTEXT]
5.El-Mostarchid B, Ali A, Maftah M, Mansouri A, Laghzioui J, Kadiri B, et al. Non-dysraphic intramedullary spinal cord lipoma: A case report. Joint Bone Spine 2002;69:511-4.  Back to cited text no. 5    
6.Lee M, Rezai AR, Abbot R, Coelho DH, Epstein FJ. Intramedullary spinal cord lipomas. J Neurosurg 1995; 82:394-400.  Back to cited text no. 6    


    Figures

  [Figure 1], [Figure 2]



 

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