Rapidly regrowing lipoma in lipomeningomyelocele: a case report

Although it is widely accepted that lipomas in lipomeningomyelocele (LMMC) are anatomically stable lesions, we present a case of rapidly growing intradural lipoma accompanied by neurological deterioration. An 8-year-old girl with rapidly regrowing LMMC was admitted to our neurosurgical clinic. She was delivered by cesarean section, and at 47 days old, she underwent detethering surgery because of aggravating weakness. We performed her detethering operation immediately rather than at 3 months as had been previously scheduled because of the rapidly growing lipoma. The second operation was performed at age 8 years because of a regrowing intradural lipoma and aggravating leg deformity. Even if LMMC is expected to be surgically corrected at 2 or 3 months after birth, lipomas could grow rapidly beyond expectation.

Close monitoring and follow-up before and after surgery is needed for optimum surgical timing, in order to avoid deteriorating neurological symptoms. The possibility of the rapid growth of intradural lipomas offers additional support for early prophylactic surgery in patients with LMMC.

The potential for rapid growth of spinal lipomas should be considered during first few months of life or even long after surgery. Early diagnosis and optimal surgery are still essential for the treatment of patients with LMMC since there is a high likelihood that residual neurological functions can be preserved.