Giant bipolar intramedullary nondysraphic spinal cord lipoma: A case report

Intramedullary spinal cord lipomas (IMSCL) are a rare entity, accounting for less than 1% of spinal tumors. Most cases are associated with lumbosacral dysraphism and occur predominantly in the pediatric population.

We report the case of an isolated bipolar lipoma, which was very large in the cervicodorsal region and small in the conus medularis. The patient was a 9-years-old male who had muscle weakness for approximately 6 months. MRI showed a hyperintense lesion on T1, which was less intense on T2, without contrast enhancement at the cervicodorsal location and the conus medularis. At his admission, the patient experienced severe decompensation with flaccid tetraplegia and abdominal respiration. He immediately underwent decompression and partial resection of the cervical lesion. The anatomical pathology evaluation confirmed the diagnosis of a lipoma.

The possibility of quality resection of intramedullary spinal cord lipomas is controversial due to the lack of a cleavage plane with the anterior tracts. Any attempt at total resection would expose the patient to the risk of neurological worsening which is often irreversible. In our case, the surgical indication was self-imposed, the main objective of which was decompression.