Spinal lipomas

Abstract

<jats:p>Lipomas of the spinal cord are among the most fascinating lesions encountered by the pediatric neurosurgeon. An understanding of spinal lipomas may, however, be difficult because the terminology used to describe the accumulations of spinal fat is confusing, inconsistently applied, and at times contradictory. An anatomical characterization of lipomas may assist in understanding these lesions. Lipomas of the spinal cord are very rare and cause symptoms related to mass effect and secondary compressive myelopathy. Lipomas of the conus medullaris (or lipomyelomeningocele) are the most common form of fatty masses in the spine and can be divided into dorsal, caudal, and transitional forms. These lesions are a manifestation of occult spinal dysraphism and a common cause of the tethered cord syndrome (TCS). The natural history of untreated lipomyelomeningocele, although incompletely understood, appears to be progressive neurological deterioration with loss of bladder control. Timely, careful surgical intervention may prevent significant neurological deterioration and progressive disability in the majority of children harboring these lesions. In surgical intervention the surgeon seeks to disrupt the connection between the fibrofatty mass and underlying cord as well as to reestablish normal anatomical planes. Several intraoperative video segments illustrating lipomyelome-ningocele resection are included in this paper. Lipomas of the terminal filum (fatty filum) are truly occult and are also associated with TCS. Surgical treatment of filum lipomas carries significantly lower risk than that for lipomas of the conus medullaris. Again, the goal of surgery is to disrupt the connection between the abnormal fibrofatty tissue and the underlying spinal cord.</jats:p>

Pediatric Spinal Cord Tumors and Masses

“…Most intradural lipomas occur in the cervical and thoracic spine. Several authors have found the cervical region to be most commonly involved in children (13). They are usually located in the dorsal part of the cord.…”

“…Intradural lipomas represent approximately 4% of all spinal lipomas (13). They can be either intramedullary or a combination of intramedullary and extramedullary (13). Most intradural lipomas occur in the cervical and thoracic spine.…”

“…Intraspinal lipomas can be divided into 3 main types: lipomyelomeningoceles (or lipoma of the conus medullaris), intradural lipomas, and fibrolipomas of the filum terminale. Intradural lipomas represent approximately 4% of all spinal lipomas (13). They can be either intramedullary or a combination of intramedullary and extramedullary (13).…”

Identical twins with lumbosacral lipomyelomeningocele

“…2,15,18 This congenital defect occurs as the result of a detachment between cutaneous ectoderm and the neural tube at approximately the 4th week of gestation. Afterward, the neural tube disposal to paraxial mesoderm may incite its differentiation into adipose tissue, and a fatty mass would be the result of its development.…”

“…Afterward, the neural tube disposal to paraxial mesoderm may incite its differentiation into adipose tissue, and a fatty mass would be the result of its development. 2 The location of this adipose tissue is often used as a criterion for classification of LMMC, including dorsal, caudal, and transitional types. 14 Regarding the cause of LMMC, as well as other types of NTDs, it is supported that both environmental and genetic factors play a part in the occurrence of this defect.…”