Lipomas of the spinal cord and cauda equina

Abstract

This report presents 18 cases of lipoma of the spinal cord or cauda equina, four of which were unassociated with congenital anomalies of the spine and 14 with such anomalies. Review of the literature shows that unassociated cases are rare, with only 100 cases reported, while those associated with congenital anomalies are more common. The patients ranged in age from 2 months to 5 years. Fourteen patients had external evidence of an abnormality in the form of a mass or dimple over the vertebral column. Plain x-ray films showed evidence of an intraspinal lesion in all cases except one. The treatment was surgical in all cases, with nine good results, eight satisfactory, and one unsatisfactory. The exact pathogenesis of spinal cord lipomas is unclear, although the high incidence of associated congenital defects, age of onset, and location of the tumors suggest a developmental origin. The tumors occupy a juxtamedullary-subpial location and are composed of firm, lobulated adult fat. Early surgery consisting of generous laminectomy, incision of the pia, and subtotal removal of the tumor is felt to be the treatment of choice. KEYWoRDs spinal cord tumor lipoma spina bifida eauda equlna tumor corns tumor congenital defect

Expansive laminoplasty for lumbar intradural lipoma

“…The results of operation in adults are not very good once neurological involvement has occurred [9], but improvement is likely when symptoms have been present for less than 2 years [4]. Two of our cases with the longest history showed no neurological improvement.…”

“…In previous reports, laminectomy was carried out at various ages [3,4,6,9,10]. Patients are young when symptoms develop and show 3 peaks of highest incidence: the first 5 years of life (24% of reported cases); the second and third decade (55%), and the fifth decade (16%) [5].…”

“…Surgical removal of an intradural spinal lipoma is virtually impossible due to extensive adhesions to surrounding neural tissues, although it is benign [9]. The young to middle aged are predominantly affected [5], so postoperative spinal stability must be considered.…”

Long term follow up of patients with cauda equina syndrome due to intraspinal lipoma

“…Even subtotal resection may relieve symp toms.8 Despite the benign connotation of lipoma, these authors state that total resec tion is not advisable, because it is hazardous in terms of damage to the cauda equina. Eighteen cases of lipomas of the spinal cord and of cauda equina were described by Rogen et al 7 Fourteen were associated with congenital anomalies of the spine and sur gical treatment was necessary.…”

Tethered cord syndrome

“…lipomyelomeningocele) than in older patients. Starting with myelomeningocele [1][2][3][4][5] , other congenital anomalies such as lipoma [6][7][8] , lipomyelomeningocele 9,10 and diastematomyelia 11,12 , were suspected to be the culprits, causing motor and sensory dysfunction and incontinence. Despite the location of these anomalies being at the caudal end of the spinal cord, it is suggested that stretching of the spinal cord was causing these neurological dysfunctions.…”