J Korean Neurosurg Soc.  2014 Aug;56(2):157-161. 10.3340/jkns.2014.56.2.157.

Regrowth of Cervical Intradural Lipoma without Spinal Dysraphism

• Son DK
• Son DW
• Choi CH
• Song GS

• KMID: 1956521
• DOI: http://doi.org/10.3340/jkns.2014.56.2.157

Abstract

A 49 years old male patient who suffered from deterioration of posterior neck pain, left hand numbness, left lower limb pain and gait disturbance for 3 years visited our outpatient department. He had been diagnosed as non-dysraphic cervical intradural lipoma and operated in August 1990. On the radiologic images, we found the regrowth of non-dysraphic cervical intradural lipoma from C2 to C7 level, which surrounds and compresses the cervical spinal cord. Previous subtotal laminectomy from C2 to C7 and severe cervical lordosis were also found. Appropriate debulking of lipoma mass without duroplasty was successfully done with intraoperative neurophysiological monitoring (IONM). We are following up the patient for 24 months via outpatient department, his neurologic symptoms such as hand numbness, gait disturbance, left lower limb pain and posterior neck pain have improved. We describe a rare case of regrowth of non-dysraphic cervical intradural lipoma.

Keyword

Spinal lipoma; Spinal cord lipoma; Extent of resection; Regrown lipoma

MeSH Terms

Animals
Gait
Hand
Humans
Hypesthesia
Intraoperative Neurophysiological Monitoring
Laminectomy
Lipoma*
Lordosis
Lower Extremity
Male
Neck Pain
Neurologic Manifestations
Outpatients
Spinal Cord
Spinal Dysraphism*

Figure

• 

  Fig. 1 Preoperative cervical plain film at the time of the first operation shows severe cervical lordosis and increased anteroposterior diameter of the spinal canal (arrow), which may suggest the presence of a mass lesion in the vertebral canal.

• 

  Fig. 2 Preoperative CT image at the time of the first operation shows a hypodense tumor mass occupying the spinal canal almost entirely. Cervical spinal cord was severely compressed and located peripherally in the spinal canal.

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  Fig. 3 Preoperative T1-weighted sagittal image at the time of the first operation shows a huge intradural mass with high signal intensity located from the C2 to C7 level. Axial image shows that this mass occupies the entire spinal canal and distorts the cervical spinal cord.

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  Fig. 4 Preoperative 3-dimensional CT images at the time of the second operation show previous subtotal laminectomy from C2 to C7 (A). The hypodense intradural mass is the recurred intradural lipoma, and it also compresses and distorts the cervical spinal cord (B).

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  Fig. 5 Preoperative T1- (A) and T2- (B) weighted MRI images at the time of the second operation show an intradural lipoma from the C2 to C7 level exhibiting high signal intensity, suggesting a regrown lipomatous mass.

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  Fig. 6 During the operation, there were severe adhesions between the cervical dura, paraspinal muscles and soft tissues. A : When we incised the cervical dura after performing dissection of adhesions, we found a huge, yellowish mass in the intradural space, and it looked like a lipomatous mass. B : After performing subtotal debulking of the lipomatous mass, we achieved adequate decompression of the spinal canal. C : Thus, we could close the cervical dura without duraplasty.

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  Fig. 7 Postoperative T1- (A) and T2- (B) weighted MRI images show that the debulked intradural lipoma at the C2-7 vertebral level exhibits high signal intensity. The low signal intensity mass on T1-weighted image and the high signal intensity mass on T2-weighted image suggest fluid collection at the surgical site, it was found to be cerebrospinal fluid.

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  Fig. 8 Peripherally located nucleus and vacant cytoplasm without fat necrosis confirm the presence of mature adipose cells, suggesting the diagnosis of lipoma (Hematoxylin and Eosin stain, ×200).

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