A case of intradual lumbo-sacral lipona in adult
Negoro, M.; Freidberg, S.R.; Yamada, H.; Kageyama, N.
No Shinkei Geka. Neurological Surgery 9(3): 410-414
1981
ISSN/ISBN: 0301-2603 PMID: 7242827 Document Number: 169619
A 36 yr old male, who had been treated for occasional urinary incontinence, recently developed weakness of his right leg with sensory impairment of L5-S1 dermatome of same leg. Anke jerk was absent on right side. No cutaneous manifestations were detected on his back. Pantopaque myelography revealed low-lying conus medullaris and enlarged dural sac. At operation laminectomy was performed. Intradural lipoma with tethered conus was found at the lumbosacral portion. There was no extension of lipoma into s.c. tissue. Tumor itself was removed subtotally and release of tethered conus was accomplished. Postoperatively patient experienced the difficulty of urination transiently, but fully recovered from his urinary symptoms within a week. His motor and sensory disturbances were unchanged despite surgery. Spinal lipoma is divided into 2 groups, cervicodorsal and lumbo-sacral lipomas. Lumbosacral lipoma is often associated with other congenital malformations like meningocele, dermal sinus etc. Because of high incidence of associated anomaly, lumbosacral lipoma is regarded as one of the occult spinal dysraphism. In rare instances no associated anomaly is found in this group of lipomas. Cervicodorsal lipoma is known to have few associated anomalies. For the diagnosis of lumbosacral lipoma, myelography has great value. Metrizamide, a newly developed water-soluble contrast media, is very useful for delineating the lipoma in its myelographic application. Recently CT scan becomes a useful diagnostic tool for spinal cord lesions. In CT scan lipoma is easy to diagnose because of its unique low absorption value. Removal of tumor without damaging the nerve root and release of tethered conus are recommended as treatment. Results of surgery are not as good once neurological involvement has occurred. Early operation is advocated.