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A comprehensive study of non-dysraphic intradural extramedullary spinal lipoma in adults: A systematic review and
Áquila Matos Soares1, Yan Gondim de Sousa2, Daniel Salmito Chaves3
1Department of Neurosurgery, General Hospital of Fortaleza, Fortaleza, Ceará, Brazil.
Background:
Spinal lipomas are defined by the premature separation of the neural ectoderm from the cutaneous ectoderm during primary neurulation. Non-dysraphic extramedullary intradural spinal lipoma (N-DEISL) represents less than 1% of spinal tumors. This study aims to analyze the anatomical and clinical presentations, and treatment strategies of N-DEISL in adults.
Methods:
We conducted a systematic review and meta-analysis of studies on N-DEISL, following PRISMA guidelines. Literature searches were performed using databases including EMBASE and PubMed. The studies included case reports, cohort studies, and clinical trials focusing on intradural-extramedullary lipoma. Data extraction and analysis were conducted by multiple reviewers, employing tools such as GraphPad Prism, R, and Python for statistical analysis and graphical representations.
Results:
A total of 36 studies encompassing 55 patients were included. Most patients were male, with a mean age of 34.60 years. Common symptoms included motor disturbances (80.00 %) and sensory disturbances (94.54 %). Diagnosis was predominantly through Magnetic Resonance Imaging (MRI) (72.72 %). Surgical treatment was applied in 94.54 % of cases, with 67.27 % reporting symptom improvement. Neurophysiological Intraoperative Monitoring (NIOM) was used in 14.54 % of patients, showing significant symptom improvement without significant recurrence. Cubic spline regression analysis revealed a non-linear relationship between intraoperative monitoring and post-surgical recovery time.
Conclusion:
Our systematic review and meta-analysis indicate that the use of NIOM can be a predictive factor in the recovery of patients with extramedullary intradural lipoma in adults. Moreover, it was found that these lipomas predominantly affect the thoracic level of the spinal cord, with definitive diagnosis primarily achieved through MRI. It was also verified that the time between the onset of symptoms and seeking medical assistance is a critical factor to be addressed. Finally, it can be inferred that, although partial resection presents remarkable results, further investigation into the role of intraoperative monitoring in future randomized studies is essential.
