Successful Surgical Excision of a Nondysraphic Holodorsal Intramedullary Lipoma in a 14-Month-Old Child

Abstract

Introduction: Nondysraphic intramedullary lipomas of the spinal cord are rare lesions. They are most commonly seen in the second or third decade of life. Their occurrence in the pediatric age group is even rarer. Case Report: The authors describe a 14-month-old child who presented with delayed motor milestones involving the bilateral lower limbs. The child was unable to sit or stand. MRI revealed a dorsally located intramedullary lipoma extending from C₇ to D₁₂. The child underwent C₇–L₁ laminotomy and gross total excision of the lipoma. Postoperatively, the child improved neurologically and attained normal power in the bilateral lower limbs. Discussion: Very few cases of extensive intramedullary lipomas involving the dorsal cord have previously been reported. Only two cases of pediatric extensive dorsal lipomas have been mentioned to date. The authors describe successful surgical excision of a holodorsal intramedullary lipoma in a 14-month-old child. To the best of the authors’ knowledge, this is the first case being reported of a holodorsal intramedullary lipoma in the youngest patient.

Extensive Multilevel Split Laminotomy for Debulking a Cervicothoracolumbar Nondysraphic Intramedullary Spinal-Cord Lipoma in a 2-Month-Old Infant

“…Our patient exhibited a nondysraphic, intramedullary lipoma that involved an extensive segment of the spinal cord; this case represents the 4th pediatric patient reported with such a long lesion [18][19][20] . He underwent an extensive, multilevel split laminotomy from C6 to L5, with subsequent external bracing.…”

Prenatal sonographic diagnosis of nondysraphic intramedullary lipomas: A case report

“…A widely accepted hypothesis is that the process of disjunction of the neural ectoderm from the cutaneous ectoderm during embryonic neurulation before neural tube closure occurs prematurely, which allows mesenchymal access to prospective groove of neural tube. 6 They grow slowly and may stay asymptomatic for a long time. [2][3][4] Lipomas can occur in any segment of the spinal canal.…”

“…[2][3][4] Lipomas can occur in any segment of the spinal canal. 2,6,7 The histopathological examination reveals features of adipose tissue consistent with lipoma. 5 Moreover, the lesions have a predilection for dorsal location in the spinal canal.…”

“…5 Moreover, the lesions have a predilection for dorsal location in the spinal canal. 6 They grow slowly and may stay asymptomatic for a long time. With enlargement of the lesions, they may produce symptoms because of compression of the adjacent spinal cord.…”

“…7 The common presentations usually include tetraplegia, retarded motor development, gait disorder, dysesthetic sensory changes, and incontinence. 2,6,7 The histopathological examination reveals features of adipose tissue consistent with lipoma.…”