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Contracciones intradurales: cirugía de lipoma espinal con actividad electromiográfica equívoca. Caso ilustrativo

Ignacio Mesina- Estarron¹, Rachel Zhang², Fernando Cotrim Gomes¹

¹Division of Pediatric Neurosurgery, Children's Hospital of Orange County, Orange.

Journal of neurosurgery. Case lessons

|January 22, 2026

Resumen

Los lipomas espinales intradurales pueden contener músculo, formando miolipomas. La neuromonitorización intraoperatoria (IONM) puede detectarlo observando la contracción del lipoma evocada eléctricamente, lo que ayuda a la descompresión quirúrgica segura.

Área de la Ciencia:

Neurocirugía
Neurología Pediátrica
Cirugía de la Médula Espinal

Sus antecedentes:

Los lipomas espinales intradurales son una causa común del síndrome de médula anclada.
Estas lesiones están típicamente compuestas de tejido adiposo, pero raramente pueden contener otros elementos histológicos.

Objetivo del estudio:

Informar sobre un caso de miolipoma espinal con hallazgos intraoperatorios inesperados.
Destacar la utilidad de la neuromonitorización intraoperatoria (IONM) en la identificación y manejo de tumores espinales tan raros.

Principales métodos:

Un niño de 13 años con un lipoma espinal se sometió a desanclaje y desbridamiento quirúrgicos.
Se empleó neuromonitorización intraoperatoria (IONM) durante el procedimiento.
La estimulación eléctrica identificó una banda distinta dentro del lipoma que se contrajo, sugiriendo tejido muscular.

Principales resultados:

El análisis histopatológico confirmó la presencia de fibras de músculo esquelético dentro del lipoma, diagnosticándolo como un miolipoma.
La contracción eléctricamente evocada del segmento del lipoma ayudó en su aislamiento y división seguros.
El paciente no experimentó déficits sensoriales posoperatorios y mostró una recuperación satisfactoria.

Conclusiones:

La contracción del lipoma evocada eléctricamente es un indicador clave de miolipoma y ayuda a delinear márgenes quirúrgicos seguros.
La IONM proporciona información crítica más allá de los potenciales evocados al detectar la contracción miogénica, ayudando a diferenciar el tumor de las estructuras neurales.
A pesar de los desafíos en la interpretación de la EMG en tales casos, la evaluación visual guiada por IONM facilita el desanclaje seguro.

Palabras clave:

reporte de caso disrafismo lipoma músculo esquelético

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