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Subdural spinal lipoma with posterior fossa extension
C J Fan1, R J Veerapen, C T Tan
1Department of Radiology, University Hospital, Kuala Lumpur, Malaysia.
Insights
Subdural spinal lipomas, particularly high cervical ones, often extend into the posterior cranial fossa. Early diagnosis with computed tomography (CT) is crucial for infants with quadriparesis to detect this extension and hydrocephalus.
Area of Science:
- Neurosurgery
- Radiology
- Pediatric Neurology
Background:
- Subdural spinal lipomas are rare congenital tumors.
- Posterior fossa extension is a significant but often overlooked complication.
- Advances in neuroimaging have improved detection rates.
Observation:
- A case of subdural spinal lipoma with posterior fossa extension is presented.
- Review of world literature indicates a high incidence of posterior fossa extension in high cervical lipomas.
- Many such cases may have been missed prior to the widespread use of computed tomography (CT).
Findings:
- Infants with posterior fossa growth often present with quadriparesis and symptoms from birth.
- High cervical lipomas visualized on myelography warrant brain CT to rule out posterior fossa involvement.
- Associated hydrocephalus is frequently observed in these cases.
Implications:
- Emphasizes the importance of comprehensive neuroimaging for suspected high cervical lipomas.
- Highlights the need for early detection and management of posterior fossa extension in spinal lipomas.
- Suggests a revised diagnostic protocol involving CT for all high cervical lipomas identified via myelography.
Abstract:
A case is described of subdural spinal lipoma with posterior fossa extension and the world literature is reviewed. A high proportion of high cervical lipomas extend into the posterior cranial fossa. Many cases were probably missed in the pre-computed tomography era. Those cases with posterior fossa growth are more likely to be found in infants or those cases with symptoms dating from birth; most present with quadriparesis. All cases of high cervical lipoma demonstrated by myelography should be submitted to brain computed tomography in order to exclude posterior fossa extension and demonstrate the presence of hydrocephalus.