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| LETTER TO EDITOR |
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| Year : 2009 | Volume
: 57
| Issue : 6 | Page : 825-826 |
Lipoma of conus medullaris without spinal dysraphism in an adult
Cheng-Ta Hsieh1, Jui-Ming Sun2, Ming-Ying Liu1
1 Department of Neurological Surgery, Tri-Service General Hospital, National Defense Medical Center, Taiwan, China
2 Department of Surgery, Songshan Armed Forces General Hospital, Taipei, Taiwan, China
| Date of Acceptance | 06-Aug-2009 |
| Date of Web Publication | 30-Jan-2010 |
Correspondence Address:
Cheng-Ta Hsieh
Department of Neurological Surgery, Tri-Service General Hospital, National Defense Medical Center, Taiwan
China
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0028-3886.59497
How to cite this article:
Hsieh CT, Sun JM, Liu MY. Lipoma of conus medullaris without spinal dysraphism in an adult. Neurol India 2009;57:825-6 |
Sir,
A 46-year-old male was admitted with a two-year history of low back pain, followed by radiating pain in the lateral aspect of left upper thigh. At admission, neurological examination showed motor weakness of grade 4/5 in both the lower limbs, hypoesthesia in the lateral aspect of left upper thigh in the L1-2 dermatomes., normal tendon reflexes and no pathological reflexes. Magnetic resonance imaging (MRI) of lumbar spine revealed an intradural ovoid mass of approximately 13 x 15 x 43 mm 3 in size occupying T11 to L1, which was hyperintense on both T1-weighted and T2-weighted images [Figure 1]a and b. He underwent T11 to L1 laminectomy. At operation, the tumor removal was subtotal as there was no obvious interface between the tumor, cord, and nerve roots. The pathological examinations confirmed the diagnosis of lipoma. Postoperatively motor weakness worsened and developed loss of anal tone, and urinary incontinence. The incontinence improved one month after the operation. Motor power in both the lower limbs improved from grade 2 to grade 4 after six months of rehabilitation.
Lipoma of conus medullaris without spinal dysraphism in an adult is a rare entity and only seven cases have been reported in the English literature till 2002. [1] Many causes such as proliferation of adipose cells, deposition of fat in the connective tissue, metaplastic differentiation of persisting embryonic meninges, and abnormal embryologic development (dysraphism) have been hypothesized for the development of these tumors. [2] The clinical presentations of intradural spinal lipoma are mainly related to the mass effect. [3] Most of these patients have the symptoms for more than two years before the diagnosis. MRI is the best diagnostic modality to evaluate spinal lipoma and delineate the adjacent neural structures. The fat component can be easily confirmed by using the fat-suppression images. Surgical intervention is indicated for the patients with progressive neurological symptoms. The goal of surgery is not only to remove the tumor, but also to preserve the neurological functions. With improvements in the neurosurgical techniques, use of carbon dioxide laser has been shown to have surgical precision, and maximal removal of the tumor with minimal surrounding trauma and improved hemostasis. Use of carbon dioxide has less electrical interference with the intraoperative evoked potential recordings. However, as there is often no clear-cut margin between lipoma and the cord, aggressive total removal of tumor is hard to achieve and is also not recommended. Partial surgical excision with wide laminectomy, laminoplasty or duroplasty also has been advocated to treat the intraspinal lipoma. [4] The management of lipoma of conus medullaris without spinal dysraphism remains a challenge.
| » References | |  |
| 1. | El Mostarchid B, Ali A, Maftah M, Mansouri A, Laghzioui J, Kadiri B, et al. Non-dysraphic intramedullary spinal cord lipoma. A case report. Joint Bone Spine 2002;69:511-4.  |
| 2. | Kasliwal MK, Mahapatra AK. Surgery for spinal cord lipomas. Indian J Pediatr 2007;74:357-62. [PUBMED] [FULLTEXT] |
| 3. | Koyanagi I, Hida K, Iwasaki Y, Isu T, Yoshino M, Murakami T, et al. Radiological findings and clinical course of conus lipoma: Implications for surgical treatment. Neurosurgery 2008;63:546-51; discussion 51-2. |
| 4. | Bekar A, Sahin S, Taskapiloglu O, Aksoy K, Tolunay S. Intradural spinal lipoma: Report of a thoracic case and a lumbar case. Turkish Neurosurgery 2004;14:52-6. |
[Figure 1]
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