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FIG. 5 Fig. 4.-Roentgenogram in a case of a spinal lipoma shows a moderate kyphoscoliosis and a widening of the pedicular distances.
Source publication
Spinal Cord is the official journal of the International Spinal Cord Society. It provides complete coverage of all aspects of spinal injury and disease.
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Split cord malformations (SCM) may be discovered as isolated occult spinal dysraphism or in association with various other overt developmental spinal abnormalities or lesions. However, the occurrence of SCM with intraspinal teratoma is rare. We report 2 cases of teratoma associated with SCM, of which one is intramedullary and the other extradural w...
Incidental or intentional durotomy causing cerebrospinal fluid (CSF) leakage, leading to the formation of a pseudomeningocele is a known complication in spinal surgery. Herniation of nerve roots into such a pseudomeningocele is very rare, but can occur up to years after initial durotomy and has been described to cause permanent neurologic deficit....
Citations
... Commonly found in the cauda equina and conus medullaris, these tumors tend to violate the posterior cord and are usually extramedullary. 61,62 Lipomas are commonly associated with spinal dysraphism and are thought to arise from premature disjunction of the cutaneous ectoderm from the neural ectoderm prior to neural tube closure, allowing mesenchymal cells to infiltrate into the neural groove. 1 These tumors possess a higher water content than other intramedullary tumors and tend to attach firmly to the dura; their cellular content is indistinguishable from normal adipose tissue. [62][63][64] These tumors are slow-growing, and they become symptomatic due to focal mass effect. ...
Study Design Broad narrative review.
Objectives Intramedullary spinal cord tumors (IMSCT) are rare neoplasms that can potentially lead to severe neurologic deterioration, decreased function, poor quality of life, or death. As such, a better understanding of these lesions is needed. The following article, part one of a two-part series, addresses IMSCT with regards to their epidemiology, histology, pathophysiology, imaging characteristics, and clinical manifestations.
Methods The authors performed an extensive review of the peer-reviewed literature addressing the aforementioned objectives.
Results Numerous IMSCT exist with varying epidemiology. Each IMSCT has its own hallmark characteristics and may vary with regards to how aggressively they invade the spinal cord. These lesions are often difficult to detect and are often misdiagnosed. Furthermore, radiographically and clinically, these lesions may be difficult to distinguish from one another.
Conclusions Awareness and understanding of IMSCT is imperative to facilitate an early diagnosis and plan management.
Background: Lumbosacral spinal lipomas and lipomyeloceles are usually identified in early childhood. Terminology, histopathology, and diagnosis for these malformations can be confusing. Materials and Methods: This is a PubMed review with comparison of embryology, gross, and histopathology, and reporting requisites for these and related closed spinal malformations. Results: The spinal lipoma group (congenital spinal lipomatous malformations) includes subcutaneous, transdural, intradural, and noncontiguous malformations stretching through the entire lower spinal region. This lipomyelocele trajectory overlaps the embryonic tail’s caudal eminence. Histopathologically, the lipomyelocele spectrum is a heterogeneous, stereotypical set of findings encountered from dermis to spinal cord. Diagnosis requires detailed correlation of images, intraoperative inspection, and histopathology. Conclusions: Appropriate terminology and clinicopathologic correlation to arrive at a diagnosis is a critical activity shared by pathologist and clinician. Prognostic and management differences depend on specific diagnoses. Familial and genetic influences play little if any role in patient management in closed spinal malformations.
In adults, the ratio between intraspinal and intracranial tumors is roughly one to four [37]. For purposes of discussion, we have divided these tumors into three major categories: (1) those extradural in location; (2) those inside the dura, but outside the spinal cord (intradural-extramedullary); and (3) those inside the spinal cord (intramedullary).
Spinal cord lipomas are rare lesions, accounting for approximately 1% of all spinal cord tumors. True intramedullary spinal cord lipomas are extremely rare and are represented in the literature as scattered, single case reports. The authors present a series of six patients with intramedullary spinal cord lipomas managed at our institution from July, 1985 to July, 1993. The patients' ages ranged from 8 to 45 years. Four patients presented with newly diagnosed tumors and two had undergone previous surgery. Patients usually presented with long histories of disability followed by rapid progression of their symptoms. Most patients were in poor neurological condition on presentation. Presenting symptoms included spinal pain, dysesthetic sensory changes, gait difficulties, weakness, and incontinence. Three patients had cervical tumors, two had cervicothoracic tumors, and one patient had a thoracic tumor. Diagnostic studies, including magnetic resonance imaging, were obtained in all patients. No patient exhibited any form of spinal dysraphism or had a dural defect. All patients underwent decompressive, subtotal resections of 40% to 70% of their lesions. Follow-up times ranged from 12 to 96 months. All patients had resolution of their pain, but they generally showed no neurological improvement. As of their most recent follow-up visit, none of the patients was neurologically normal; three can function independently, although with neurological deficits. The other three patients cannot function independently and have severe neurological deficits. The authors conclude that patients with intramedullary spinal cord lipoma who present with significant neurological compromise have a very poor prognosis with regard to neurological function and generally show no improvement with surgical resection.
