Large subpial lipoma of the dorsolumbar spinal cord in a pediatric patient

BackgroundIsolated spinal cord lipoma in the absence of congenital abnormalities is a rare cause of compressive myeloradiculopathy and accounts only for about 1% of all intraspinal tumors. We present an extensive subpial dorsolumbar spinal cord lipoma in a child with mild neurological symptoms and scoliosis.Case reportAn 8-year-old female patient was transferred to our hospital for evaluation of urinary and anal sphincter dysfunction. Urinary tract ultrasound, cystography and urodynamic evaluation were normal. Spinal X-ray showed a discrete right dorsal scoliosis and a widened dorsolumbar spinal canal. Therefore, MRI was performed and an extensive subpial spinal cord lipoma (D1–L4) was diagnosed. The lesion demonstrated characteristic high signal intensity on T1- and T2-weighted images and suppression on fat saturation sequences. No contrast enhancement was seen. The patient did not have severe neurological symptoms, so conservative management was chosen. Clinical exam and MRI follow-up 2 years later were unchanged.DiscussionIn children, spinal cord lipoma often presents with nonspecific symptoms such as hypotonia, retardation of ambulation or back pain. MRI is the best imaging modality for diagnosing intraspinal lipomas. Differentiation between intra- versus extramedullary lipoma is difficult. When nerve roots traversing the lipoma are observed, subpial origin can be assumed. Thus far, the questions of whether all spinal lipomas need surgery and does prophylactic surgery prevent neurological deterioration are not clearly answered. Therefore, the therapeutic approach has to be evaluated individually.