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    Ajr v8 Id1157

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    1) An 8-month-old child presented with excessive crying, developmental delay, and difficulty supporting their neck and trunk. MRI revealed a rare nondysraphic intradural spinal lipoma extending from the craniocervical junction to the thoracic spine. 2) The lesion was intradural, difficult to characterize as intramedullary or extramedullary, and caused compression of the spinal cord. A partial resection was performed for decompression. 3) Intradural lipomas without dysraphism are exceptionally rare but can be clearly diagnosed with MRI. Surgical treatment aims to decompress the spinal canal without requiring full excision of the lesion.

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    Ajr v8 Id1157

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    jenifer paath
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    1) An 8-month-old child presented with excessive crying, developmental delay, and difficulty supporting their neck and trunk. MRI revealed a rare nondysraphic intradural spinal lipoma extending from the craniocervical junction to the thoracic spine. 2) The lesion was intradural, difficult to characterize as intramedullary or extramedullary, and caused compression of the spinal cord. A partial resection was performed for decompression. 3) Intradural lipomas without dysraphism are exceptionally rare but can be clearly diagnosed with MRI. Surgical treatment aims to decompress the spinal canal without requiring full excision of the lesion.

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    1) An 8-month-old child presented with excessive crying, developmental delay, and difficulty supporting their neck and trunk. MRI revealed a rare nondysraphic intradural spinal lipoma extending from the craniocervical junction to the thoracic spine. 2) The lesion was intradural, difficult to characterize as intramedullary or extramedullary, and caused compression of the spinal cord. A partial resection was performed for decompression. 3) Intradural lipomas without dysraphism are exceptionally rare but can be clearly diagnosed with MRI. Surgical treatment aims to decompress the spinal canal without requiring full excision of the lesion.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    10 views2 pages

    Ajr v8 Id1157

    Uploaded by

    jenifer paath
    1) An 8-month-old child presented with excessive crying, developmental delay, and difficulty supporting their neck and trunk. MRI revealed a rare nondysraphic intradural spinal lipoma extending from the craniocervical junction to the thoracic spine. 2) The lesion was intradural, difficult to characterize as intramedullary or extramedullary, and caused compression of the spinal cord. A partial resection was performed for decompression. 3) Intradural lipomas without dysraphism are exceptionally rare but can be clearly diagnosed with MRI. Surgical treatment aims to decompress the spinal canal without requiring full excision of the lesion.

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    Open Access

    Austin Journal of Radiology

    Case Report

    Nondysraphic Intradural Spinal Lipoma: A Rare Case in a


    Child
    Antonio GL Jr.1*, Abreu NMP1, Leal MVB1,
    Abstract
    Rodrigues JPC1, Malveira C1, Gomes LVM2 and
    Coimbra PPA1 Lipoma is a rare and benign tumor, with lesions associated with spinal
    1
    Radiology Unit, Hospital Antonio Prudente, Fortaleza, dysraphisms. The reported case is about an 8-month-old child who arrived
    CE, Brazil at the hospital with developmental delay, excessive crying, undergoing MRI
    2
    UniRV, Goianésia, GO, Brazil and reported spinal cord lipoma. Intradural lipomas without association with
    *Corresponding author: Antonio Gomes Lima Junior, dysraphism are difficult to diagnose, being the most accurate form of MRI.
    Radiology Unit, Hospital Antonio Prudente, Fortaleza,
    Keywords: Lipoma; Pediatric; Diagnostic Imaging; Radiology
    CE, Brazil
    Received: July 20, 2021; Accepted: August 24, 2021;
    Published: August 31, 2021

    Introduction
    Spinal cord lipomas represent a group of rare and benign tumors.
    It accounts for about 1% of all intramedullary tumors. These are
    injuries associated with spinal dysraphisms. The absence of association
    with dysraphism makes the lesion even rarer, representing about 1%
    of cases of spinal cord lipomas. The case to be discussed is a child
    diagnosed with intradural lipoma without associated dysraphism.
    Case Presentation
    The case reported is of an 8-month-old child, who started a
    condition of excessive crying associated with stooped posture in
    the cervical and thoracic region at 3 months of age, in a progressive
    manner. Report evaluated by an orthopedist who discarded
    Figure 1: Sagittal/T1 image - T1-weighted hyperintense lesion extending
    pathological processes. She had motor development delay, with
    from the craniocervical transition to the thoracic spine.
    difficulty in supporting her neck, trunk, without sitting down
    at 7 months. Hospitalized at 8 months due to gastrointestinal
    symptoms, where fontanelle bulging was observed, and a blood CT
    was requested, which showed an expansive lesion in the posterior
    fossa with insinuation to the spinal canal. Blood MRI was performed
    showing an image compatible with spinal cord lipoma, without signs
    of associated dysraphism. She underwent a surgical procedure, where
    the tumor was partially resected due to the extension of the lesion. He
    is still hospitalized in ventricle bypass planning (Figure 1-4).
    Discussion
    Medullary lipomas are very rare entities, especially when there is
    no association with dysraphisms, representing about 1% of all spinal
    lipomas and 5-7% in children, as reported in this case [1]. Most are
    intradural (60%), while the rest are extradural (40%). The clinical Figure 2: Sagittal image/T2 - Lesion with marked drop in T2-weighted signal
    presentation and its neurological component are quite variable extending from the craniocervical transition to the D4 thoracic vertebra.
    depending on the size and location of the lesion, but it usually evolves
    insidiously [2]. The case in question presented early symptoms with structures. They usually have a high signal on T1 and a low signal on
    motor delay due to the significant tumor volume [3]. This condition T2. The treatment of these injuries is surgical, with the main objective
    is more commonly located in higher regions of the spinal cord, of spinal cord decompression, without the need for complete excision
    especially in the projections of the 4th and 5th thoracic vertebrae. In the of the tumor, with several reports of worse postoperative results in
    case reported here, there is involvement from the 4th vertebra to the case of total excision. Contraindicated in asymptomatic patients. In
    posterior cranial fossa. MRI is the main diagnostic method, not only the case patient, a partial excision with spinal decompression was
    for confirmation, but also for evaluating the involvement of adjacent performed [4].

    Austin J Radiol - Volume 8 Issue 8 - 2021 Citation: Antonio GL Jr, Abreu NMP, Leal MVB, Rodrigues JPC, Malveira C, Gomes LVM, et al. Nondysraphic
    ISSN : 2473-0637 | www.austinpublishinggroup.com Intradural Spinal Lipoma: A Rare Case in a Child. Austin J Radiol. 2021; 8(8): 1157.
    Antonio et al. © All rights are reserved
    Antonio GL Jr. Austin Publishing Group

    The lesion has an intradural situation, difficult to characterize


    whether intra or extramedullary, but occupying the posterior aspect
    of the spinal canal, determining its enlargement, with anterolateral
    displacement to the left of the spinal cord and bulbomedullary
    transition, which is compressed and deformed, areas of thinning and
    signal alteration characterized by hypersignal on T2/STIR, denoting
    some degree of compressive myelopathy.
    Conclusion
    Intradural lipomas without association with dysraphism are
    rare conditions common in the literature, where the diagnosis is
    usually made clearly and objectively with MRI. Surgical treatment
    has as main objective the decompression of the spinal canal, with
    Figure 3: Axial/T1 Fat-Sat Pos Contrast image - Lesion with marked signal no need for complete excision of the lesion and contraindicated in
    drop in the sequences with fat saturation and no contrast uptake, intradural asymptomatic patients.
    and difficult to characterize if extra or intramedullary.
    Although there has been improvement in prenatal diagnosis in
    recent years, adequate clinical, pre- and post-surgical management
    is still quite challenging, mainly due to the rarity of the disease,
    generating limited information for the production of adequate
    treatment protocols of this pathological condition.
    References
    1. So Wan-Soo, Lee Woo-Jong, Choi Ha-Young, Eun Jong-Pil. Spinal
    intramedullary lipoma without dysraphism. Journal of Korean Neurosurgical
    Society. 2007; 42: 42-45.

    2. Pasalic I, Brgic K, Nemir J, Kolenc D, Njiric N & Mrak G. Intramedullary


    Spinal Cord Lipoma Mimicking a Late Subacute Hematoma. Asian journal of
    neurosurgery. 2018; 13: 1282-1284.

    3. Falavigna, Asdrubal, Segatto, Ana Claudia, & Salgado, Karine. A rare case
    of intramedullary lipoma associated with cyst. Arquivos de Neuro-Psiquiatria.
    2001; 59: 112-115.

    4. Vasudha Patwardhan, Tufail Patanakar, Diane Armao and Suresh K


    Figure 4: Axial image/FLAIR - Medulla undergoes compressive effect of the Mukherji. MR Imaging Findings of Intramedullary Lipomas. American Journal
    lesion with change in signal/hypersignal in the FLAIR sequence, translating of Roentgenology. 2000; 174: 1792-1793.
    compressive myelopathy.
    5. Bekar Ahmet, Sahin Soner, Taşkapiloǧlu Ö, Aksoy Kiymet, Tolunay Ş.
    Intradural spinal lipoma: Report of a thoracic case and a lumbar case. Turkish
    Lobulated expansive formation, well delimited and with regular Neurosurgery. 2004; 14: 52-56.
    contours, with signal intensity similar to fat, is characterized in the
    medullary canal, extending from a thoracocervical transition at the
    level of the vertebral body of D4 to the posterior cranial fossa, at the
    level of the obex, suggestive of lesion of lipomatous origin, measuring
    at least 8.9 x 4.0 x 3.1 cm in its longest axes (caudal blood/lateral/
    anteroposterior) [5].

    Submit your Manuscript | www.austinpublishinggroup.com Austin J Radiol 8(8): id1157 (2021) - Page - 02

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