Nondysraphic cervicomedullary intramedullary lipoma

Spinal cord lipomas are usually associated with spinal dysraphism and is most common in lumbosacral region. Spinal intradural lipoma is a rare condition accounting for less than 1% of spinal cord tumours and is most prevalent in cervicodorsal region. Intramedullary spinal cord lipoma of cervical spine not associated with spinal dysraphism is one of the rarest lesions. They usually present insidiously with slowly progressive myelopathic deficits. We present a case of nondysraphic intramedullary spinal cord lipoma with exophytic component and intracranial extension. A 30 year male patient presented with wasting of muscles of left shoulder and left forearm with resultant weakness for last two months and myelopathic signs. Magnetic resonance imaging revealed a T1 hyperintense , T2 hypointense lesion on the dorsal aspect of cervical spinal cord with intracranial extension and exophytic component. There was no contrast enhancement, fat suppression image indicated a lipoma. The patient underwent cervical laminectomy with foramen magnum decompression with subtotal resection of intramedullary lipoma. Histopathology examination confirmed the diagnosis of lipoma. Subtotal resection of intramedullary lipoma is a reasonable and acceptable surgical option considering the benign nature of lesion and high probability of neurological deterioration due to dense adhesion between lipoma and neural tissue.