Recurrent 'universal tumour' of the spinal cord

Abstract

SummaryLipoma is popularly known as the 'universal tumour' because of its ubiquitous presence anywhere in the body. This is the first documented case of recurrent thoracic spinal cord intramedullary lipoma in a 44-year-old man, with a background of spinal dysraphism, which recurred 15 years after initial surgery. He was followed up every 2 years and currently presented with an 8-month history of progressive weakness in his lower limbs. An MRI of the spine confirmed recurrence of lipoma. He underwent redo laminectomy and partial resection and spinal cord decompression with duroplasty. Lipoma, although a low-grade tumour, can cause significant neurological deficits because of its location. Surgical exploration and removal of lipoma is recommended. However, to preserve the functionality of the spinal cord, one may resort to partial resection and aim for spinal cord decompression. The literature on spinal cord lipoma is reviewed and the aetiopathogenesis of this rare occurrence is described. BACKGROUND

Regrowth of Cervical Intradural Lipoma without Spinal Dysraphism

“…Since Elsberg et al 5) reported about the danger associated with total removal of spinal cord lipomas, which caused postoperative quadriplegia in 1925, many authors have changed their management strategy from conservative care to operation. Recently, several authors agree that proper treatment of these lesions includes surgical removal using microsurgical techniques with IONM in order to preserve the normal neurological tissues 2 , 6 , 10 , 12 , 14 , 16 , 17) . Adequate bony decompression is also recommended.…”

“…Meanwhile, the relationship between growth of these lesions and lipid metabolism was reported and debated by many authors 1 , 2 , 6 , 10 , 14 , 16) . Fleming et al 6) described 5 cases of non-dysraphic pediatric intramedullary spinal cord lipomas in 2010; they reported 2 cases of recurrence, and re-operation was needed in these 2 cases.…”

“…All of the authors had a similar opinion that further clinical and experimental studies are necessary for confirming the conclusions. To the best of our knowledge, only a few articles have reported regarding regrowth of cervical intradural lipomas 6 , 14 , 16) . Therefore, more studies are needed to understand the relationship between regrowth of cervical intradural lipomas and lipid metabolism.…”

“…On reviewing the literature, we found that articles which demonstrate regrowth of spinal cord lipomas are uncommon, and we managed to find some articles on this subject 6 , 14 , 16) . In this article, we present our recent experience about regrowth of cervical intradural lipoma without spinal dysraphism.…”

Thoracic intramedullary lipoma in a 3-year-old child: Spontaneous decrease in the size following incomplete resection

“…Nondysraphic intramedullary spinal cord lipomas are even rarer. [ 1 2 3 4 ] They are believed to be hamartomas occurring as a result of disordered embryogenesis, therefore, the fat tissue of intraspinal lipomas behave according to the general fat metabolism of the patient. [ 1 5 ] We present a 3-year-old girl with a thoracic intramedullary lipoma which spontaneously decreased in size following surgical debulking.…”