Adult intradural lipoma with tethered spinal cord syndrome

Abstract

A 48-year-old woman presented to our imaging department with lumbar sciatica. The patient had a medical history of low back pain and spina bifida. A transverse section lumbar spine CT-scan, obtained with soft-tissue window setting (Fig. A, arrow) showed, a fat-density (45-HU), oblong, posterior intradural supracentimetric lesion, at level of L5-S1. The use of bone window setting revealed a spina bifida at L4-L5-S1 (Fig. B, arrow). Lumbar spine MRI performed shortly afterwards confirmed the presence of a posterior intradural supra centimetric lesion, at level of L5-S1, hyperintense on T1 (Fig. C, arrow) and T2, and hypointetense on T2 Stir weighted imaging (Fig. D, arrow), and showed that the filum terminale was attached to the aforementioned lesion.It also demonstrated that the conus medullaris was in an abdormally low position, set at the spinal level of L3-L4.Intradural spinal lipoma with tethered spinal cord was diagnosed. The patient will benefit from physiotherapy and a surgical option could be envisaged according to the clinical evolution. CommentMedullary lipomas are rare tumors that account for approximately 1% of all spinal cord tumors. In children, they are responsible for tethered spinal cord syndrome in 25% to 30% of cases. The main anatomical features of this syndrome include a stretched and thickened filum terminale (over 2 mm), a conus medullaris located below L2, and a spinal cord that is attached to the posterior wall of the dural sac (by the lipoma). The most common causes of tethered spinal cord syndrome are spinal lipomas (including intradural lipomas, lipomyelomeningocele and lipoma of the filum terminale), which account for 72% of all cases. Other causes include thin filum terminale (< 2 mm in diameter) of no fatty consistency, diastematomyelia and myelomeningocele.Three clinical syndromes can be distinguished: the neuro-orthopedic syndrome, which associates sensory, motor, and trophic deficits (pain being the main symptom in adults), the lumbosacral cutaneous syndrome, which associates a dermal sinus, a subcutaneous swelling, or an angioma (absent in 70% of cases in adults, but at least one lesion is present in 90% of cases in children), and sphincter disorders (80% of all cases).As in all other spinal cord lesion, MRI provides the best imaging technique for spinal dysraphism. It is an essential technique for the preoperative assessment of this type of lesion, as CT-scans offer poor soft tissue discrimination, and don't allow sufficient study of the spinal cord, or its relation to the lipoma.Lipomas spontaneously appear hyperintense on T1, and isointense relative to subcutaneous fat on T1 and T2. The use of gadolinium is of no interest as there would be no signal modification.

Surgical treatments on adult tethered cord syndrome

“…[13] The growth of body weight and the use of hormones may cause the increase of lipoma and increased symptoms of TCS. The low growth ability of lipoma also leads to the problem that whether the tumor should be removed completely or not.…”

Tethered spinal cord syndrome associated with spina bifida: clinical and radiological characteristics and indications for surgery (systematic review of the literature)

“…Таким образом, МРТ является золотым стандартом диагностики, а основные МР-критерии фиксации спинного мозга обоснованы Horrion et al в 2014 г. [19]:…”

Massive Lumbosacral Subcutaneous Exudate After Surgical Treatment of a Large Lipomyelocele

“…Lipomyelocele is the most common type of occult SB and often occurs in the lowest part of the spine. 2 Generally, the tethered spinal cord needs to be surgically untethered or released to prevent or minimize symptoms. 3 , 4 We present the case of a 23-year-old woman with a large lumbosacral lipomyelocele, located both inside and outside the spinal canal, associated with occult SB and tethered spinal cord.…”