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LETTER TO EDITOR
Year : 2012  |  Volume : 60  |  Issue : 3  |  Page : 350-351

High cervical nondysraphic intradural extramedullary lipoma


1 Department of Neurosurgery, Neuro Hospital, Jahada Road, Biratnagar-13, Nepal
2 Department of Anesthesiology, Neuro Hospital, Jahada Road, Biratnagar-13, Nepal

Date of Submission04-Apr-2012
Date of Decision27-Apr-2012
Date of Acceptance14-May-2012
Date of Web Publication14-Jul-2012

Correspondence Address:
Yam B Roka
Department of Neurosurgery, Neuro Hospital, Jahada Road, Biratnagar-13
Nepal
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.98540

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How to cite this article:
Roka YB, Shrestha M, Puri P R, Adhikari HB. High cervical nondysraphic intradural extramedullary lipoma. Neurol India 2012;60:350-1

How to cite this URL:
Roka YB, Shrestha M, Puri P R, Adhikari HB. High cervical nondysraphic intradural extramedullary lipoma. Neurol India [serial online] 2012 [cited 2020 Apr 1];60:350-1. Available from: http://www.neurologyindia.com/text.asp?2012/60/3/350/98540


Sir,

Spinal intradural lipomas are usually associated with spinal dysraphism and located in the cervicothoracic or thoracic levels. They are rare and account for 1% of all spinal tumors. [1] Lipomas without associated spinal dysraphism are even rarer. These can present in isolation, with lipoma in other regions of the spinal cord or even with intracranial extension. [2],[3]

A 32-year-old male presented with progressive weakness of all four limbs associated with difficulty in using his fingers, difficulty in walking, and numbness of both hands for the past nine months. He was able to ambulate with support and had no bowel or bladder involvement. Clinical examination did not reveal any cranial nerve pathology or spinal deformity. Local examination of the cervical spine did not reveal any spinal dysraphic cutaneous lesions like hair, sinus, fistula or dimples. Motor examination revealed quadriparesis with motor power of 3 / 5 and sensory loss over cervical 5 to 7 dermatomes bilaterally, but more on the right hand. Magnetic resonance imaging (MRI) of the cervical spine revealed a T2 hyperintense, dorsolateral mass, with suppression in the T2 fat inversion sequence between C and T1 segments, extending toward the right side, with severe compression of the cord [Figure 1]a and b. There was widening of the spinal canal at the same levels. Laminectomy was done, and the lipoma was visualized as a yellow, well-defined lesion on opening the dura. The spinal canal was expanded with a thinned out lamina. The lipoma was removed under a microscope and the deeper section was ill-defined. It was found to be densely adherent to the spinal cord, with numerous entering-exiting nerve roots. Subtotal excision was done and the densely adherent parts were left behind. Postoperatively there was reduction in the feeling of numbness and the motor power improved to 4 / 5 at the end of four months. The histopathology was consistent with lipoma [Figure 2]. He is presently able to walk without support and do minor activities at home. Repeat MRI at four months showed minimal residual lipoma with adequate expansion of the spinal cord [Figure 3]. Regular follow-up for the last nine months has been uneventful.
Figure 1: (a) Preoperative MRI showing hyperintense elongated dorsal mass with severe cord compression (b) and displacement of the cord to the left, with expansion of the spinal canal

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Figure 2: H and E stain showing lobules of mature adipose tissue (lipoma)

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Figure 3: Postoperative MRI showing near total excision with expanded spinal cord and remnants of lipoma at the superior and inferior margins

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Non-dysraphic spinal intradural lipomas are rare. Spinal lipomas constitute approximately 1% of all spine tumors, and of these, cervical lipomas account for only 13%. [1] These can be associated with lipomas at other sites or may have an intracranial extension. [2],[3],[4],[5] These lesions are commonly seen in children and young adults, with no gender difference. [5] The exact pathogenesis is unclear, but it could be due to a trapped adipocyte during embryogenesis, during the neural tube formation stage. This is thus a hamartoma rather than a true neoplasm. [6] These are slow growing tumors, which cause progressive symptoms over the years. The clinical presentation is usually a long duration of nonspecific symptoms, which then progress to numbness, altered gait, spasticity of the limbs and bowel or bladder disturbances. MRI remains the best investigation, not only for a diagnosis, but also for knowing the extent of the lesion and its relation with the cord. [7] Microsurgical excision with or without duroplasty is the treatment of choice. Surgery, however, may be limited by the adherence of the lipoma to the cord, due to the encapsulated nerve roots, and hence, subtotal excision with regular follow-up is the best option.

 
  References Top

1.Khurana V, Kishore D, Gambhir IS. High cervical intradural lipoma. Postgrad Med J 2010;86:251-2.  Back to cited text no. 1
[PUBMED]  [FULLTEXT]  
2.Muthusubramanian V, Pande A, Vasudevan MC, Ramamurthi R. Concomitant cervical and lumbar intradural intramedullary lipoma. Surg Neurol 2008;69:314-7.  Back to cited text no. 2
[PUBMED]  [FULLTEXT]  
3.Sanli AM, Türkoðlu E, Kahveci R, Sekerci Z. Intradural lipoma of the cervicothoracic spinal cord with intracranial extension. Childs Nerv Syst 2010;26:847-52.  Back to cited text no. 3
    
4.Takatani T, Arai H, Fujii K, Yasuda T, Kohno Y. A posterior fossa lipoma extending into the cervical spine and subcutaneous space via a cranium bifidum. Brain Dev 2008;30:603-5.  Back to cited text no. 4
[PUBMED]  [FULLTEXT]  
5.Fujiwara F, Tamaki N, Nagashima T, Nakamura M. Intradural spinal lipomas not associated with spinal dysraphism: A report of four cases. Neurosurgery 1995;37:1212-5.  Back to cited text no. 5
[PUBMED]  [FULLTEXT]  
6.Mohindra S, Gupta SK. Cervicobulbar intramedullary lipoma. Spine J 2009;9:12-6.  Back to cited text no. 6
[PUBMED]  [FULLTEXT]  
7.Kodama T, Numaguchi Y, Gellad FE, Sadato N. Magnetic resonance imaging of a high cervical intradural lipoma. Comput Med Imaging Graph 1991;15:93-5.  Back to cited text no. 7
[PUBMED]    


    Figures

  [Figure 1], [Figure 2], [Figure 3]

This article has been cited by
1 Regrowth of Cervical Intradural Lipoma without Spinal Dysraphism
Doo Kyung Son,Dong Wuk Son,Chang Hwa Choi,Geun Sung Song
Journal of Korean Neurosurgical Society. 2014; 56(2): 157
[Pubmed] | [DOI]



 

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