Neurosurgical Diseases and Disorders (M-Z) / Spinal Cord Lipomas & Lipomyelomeningoceles

Lipomas

• General Information
  • A spinal cord lipoma is fat within the normally positioned spinal cord without any skin or bony abnormalities.
  • Most commonly these rare lesions are located within the thoracic spinal cord.
  • They may be symptomatic and appear most often in adults.
    
    
• Symptoms
  • Spinal cord compression can cause numbness and tingling, weakness, difficulty with urinating or bowel movements, incontinence, and stiffness of the extremities.
    
    
• Treatment
  • A laminectomy is performed to gain access to the spinal cord. The goal of surgery is to reduce the size of the lipoma, not total removal of the fat. No other treatment method is recommended.

Lipomyelomeningocele

• General Information
  • This is a lesion present at birth that is associated with spina bifida (congenital failure of the spinal bones to close).
  • The condition is associated with abnormal fat accumulation that starts below the skin and extends through the bony opening to the spinal cord.
  • These lesions become evident within the first few months to years of life and affect females more than males in a 1.5 to 1 ratio.
    
    
• Symptoms
  • More than 90 percent of patients will have an obvious soft tissue swelling over the spine in the lower back. These lesions are covered by skin and are not painful.
  • Patients may lose neurological function within the first few weeks after birth but more typically function deteriorates over a period of months to years.
  • Neurological symptoms usually include weakness, and bladder and bowel incontinence. The weakness may be symmetrical or asymmetrical and may result in atrophy of the lower extremities.
  • In older adolescents and adults, pain may be the driving force to bring the patient to a doctor. The pain may radiate and be difficult to describe. Back mobility may be limited.
    
    
• Diagnosis
  • MRI has become the imaging procedure of choice for lipomyelomeningoceles and spinal cord lipomas. These scans give extraordinary anatomical details that help the surgeon plan the operative procedure.
  • Plain x-rays show spina bifida in most cases.
    
    
• Treatment
  • The goals of surgery are to release the attachment of the fat (tethering) to the spinal cord and reduce the bulk of the fatty tumor.
  • Simple cosmetic treatment does not prevent neurologic difficulties and may make later, more complete treatment difficult.
  • Surgical treatment is recommended when the patient reaches age 2 months or at the time of diagnosis if symptoms occur at a later age.
    
    
• Outcome
  • With surgery, 19 percent of patients will improve, 75 percent will be unchanged, and 6 percent will worsen.