Inoue Takuro, Hirai Hisao, Shima Ayako, Suzuki Fumio, Matsuda Masayuki, Fukushima Takanori
Department of Neurosurgery, Subarukai Kotoh Kinen Hospital, Shiga, Japan.
Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA.
Case Rep Neurol. 2019 May 23;11(2):183-188. doi: 10.1159/000500565. eCollection 2019 May-Aug.
Intradural spinal lipomas are rare in an adult population. They are mostly asymptomatic and usually associated with spinal dysraphism in a pediatric population. We report a rare case of spinal lipoma without dysraphism and with progressing hemiparesis. A 60-year-old woman had incidental lipoma at the craniocervical junction observed for more than 5 years. Recently, she developed right-sided hemiparesis and sensory disturbance. Radiological studies revealed a large lipoma compressing the dorsal medulla and C1-C2 spinal cord. Standard midline suboccipital craniotomy and C1 laminectomy were performed, and the lipoma was removed subtotally. The lipoma showed severe adhesion to the dorsal medulla and C1 spinal cord; therefore, the excision was limited as internal debulking. Her neurological deficit subsided within 6 months after the decompressive surgery. Considering the benign nature of lipoma, internal decompression is a reasonable management for this lesion.
硬脊膜内脊髓脂肪瘤在成人中较为罕见。它们大多无症状，在儿童人群中通常与脊髓发育异常相关。我们报告一例罕见的无脊髓发育异常且伴有进行性偏瘫的脊髓脂肪瘤病例。一名60岁女性在颅颈交界处发现偶然存在的脂肪瘤已5年多。最近，她出现了右侧偏瘫和感觉障碍。影像学研究显示一个大的脂肪瘤压迫延髓背侧和C1 - C2脊髓。实施了标准的枕下中线开颅术和C1椎板切除术，并部分切除了脂肪瘤。该脂肪瘤与延髓背侧和C1脊髓严重粘连；因此，切除仅限于内部减压。减压手术后6个月内她的神经功能缺损症状消退。考虑到脂肪瘤的良性性质，内部减压是对此类病变的合理治疗方法。
