Intramedullary migration of spinal cord lipoma

Abstract

Spinal cord lipomas may grow with changes in body fat, and can produce neurological manifestations due to nervous tissue compression or cord tethering. It is very unusual for the tumour to migrate from one part of the cord to another, thus to cause neurological symptoms at the migrated level. This, however, is a report on such a case. To the best of our knowledge, this has not previously been described in the literature. Case illustrationA 45 year old man presented to a different neuroscience centre with a history of deformity of the right foot since childhood. In his 20s, he developed numbness of the right foot, back pain, right sciatica, and a degree of urgency of micturition and of constipation. In 1998, he developed intermittent intercostal pain and was found to have reduced sensation in the left T4 to T12 region. In October 1998, an MRI scan of the spine showed a low lying tethered cord at L3 with a terminal lipoma of variegated appearance. There was a lipomatous lesion extending cranially to the T10 vertebral level. The lipomatous lesion was thought to be within the cord (fig 1). No visible syrinx could be seen in the caudal portion of the cord.In the referring neurosurgical unit, a thoracic laminectomy was carried out in January 2000. However, no intradural abnormality was found; the cord appeared normal. A needle aspiration was performed but no abnormal tissue was identified. Following the surgery, the intercostal pain resolved.Nine months before referral to our unit, the patient developed numbness in the C8 distribution of the left hand. Examination revealed normal strength in the upper limbs with diminished reflexes in the left arm. There was reduced pinprick sensation from C8 to L4 on the left and from T4 to S4 on the right. Proprioception was affected in the right foot. Clonus was present in the right ankle. The right lower leg was wasted and there was pes cavus deformity. There was grade 3 weakness of right ankle eversion. Spinal examination was normal except for the surgical scar.Review of the original MRI scan (fig 1) suggested the presence of a dermoid cyst at L2/3 intimately related to the lipomatous tissue. A further MRI scan in 2001 (fig 2) showed that the lipomatous tissue lying within the cord had extended to the C6 level, but that the amount of lipomatous tissue in the lower cord had reduced as compared with the first scan. The nature of this tissue was confirmed as fat by a fat suppression MR sequence. In the lower region of the spinal cord it was now possible to see a syrinx cavity, the presence of which had been obscured by fat on the initial MRI scan.As the patient's clinical deterioration had stabilised at this stage, we decided to adopt a conservative policy. DiscussionTethered cord is known to be associated with spinal cord lipomas.1 Terminal lipomas are spinal cord lipomas that are inserted in the end of the conus and incorporated in the filum. They may contain excessive amounts of non-adipose mesenchymal derivatives such as cartilage, bone, and fibrous septums. 2Tethering of the sp...

Surgical Management of Nondysraphic Giant Thoracic Intramedullary Lipoma: A Case Report

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Thoraco-lumbar nondysraphic intramedullary spinal cord lipoma with an unusual aspect on MRI

“…When located in the cervical region, it may extend into the intracranial space 1,25,26 , and a case of massive intracranial extension with subsequent development of hydrocephalus was reported 18 . There is also a report of migration of intramedullary lipoma in a patient presenting with symptoms of migratory myelopathy 17 . As intramedullary lipomas present with nonspecific symptoms of compromise of the spinal cord, diagnosis can only be confirmed by MRI.…”