Surgical management of spinal "Subpial" lipomas

This study reports five cases of subpial lipomas via a new grouping method with respect to the cases' distinctive magnetic resonance imaging characteristics to provide insight into the management of this entity.

From January 2013 to December 2014, five cases of pathologically diagnosed subpial lipomas that received surgical treatment in our department were included. The clinical histories and medical records were carefully reviewed, and the radiological characteristics were periodically inspected after surgery. The preoperative radiology and symptoms were reviewed with regard to outcome.

All five patients were confirmed as having lipomas based on their histological results. Total removal was achieved in one patient only, with partial removal in the other four patients. Neurological deterioration was observed in all patients immediately after surgery, with a typically lower McCormick score. Two of the patients returned to preoperative level one year later. Based on radiological traits, the lipomas could be divided into "simple" and "invasive." The syrinx formation and neurological recovery were different between these two kinds of lipoma.

Surgery for subpial lipomas without dysraphisms is frequently accompanied by neurological deterioration, temporally or permanently. Thus, this new classification of subpial lipomas into "simple" and "invasive" based on radiological traits may be valuable for making better surgical decisions.