Adhimarta Willy, Islam Andi Asadul, Kurniawan Venansius Ratno, Otniel James, Faruk Muhammad
Department of Neurosurgery, Faculty of Medicine, Universitas Hasanuddin, Makassar, Indonesia.
Department of Surgery, Faculty of Medicine, Universitas Hasanuddin, Makassar, Indonesia.
Int J Surg Case Rep. 2023 Aug;109:108616. doi: 10.1016/j.ijscr.2023.108616. Epub 2023 Aug 3.
Spinal tumors constitute 15 % of all tumors in the central nervous system. Pain is often the initial symptom, which can be localized, nocturnal, or radiated to the arms and/or limbs. We report a rare case with a subpial lipoma in the cervicothoracic spine and review the current literature.
A 22-year-old female presented with the chief complaint of tetraparesis for three months before admission. Magnetic resonance imaging revealed an intradural tumor on the fifth cervical to fourth thoracic vertebrae. She underwent a laminectomy to remove the tumor completely. Histopathological examination revealed a proliferation of mature fat cells amongst fibrous connective tissue. Surrounding nerve fibers and erythrocyte-filled blood vessels were also found, suggesting a subpial fibrolipoma. Postoperatively, there was an improvement in muscle strength six weeks after surgery. Motoric strength was grade 5 for the upper extremities and grade 4 for the lower extremities.
In this patient, cervicothoracic laminectomy and tumor removal were performed without instrumentation. Total tumor resection is the primary goal when removing a pathological lesion. However, this depends on the lesion's adhesion to the surrounding tissue. Therefore, partial tumor resection may be possible, given the neurological complications that can occur.
Because subpial lipomas are rare, their treatment is highly specialized. An assessment of the patient's physical condition and imaging assessments can provide information about potential treatment strategies and outcomes.
脊柱肿瘤占中枢神经系统所有肿瘤的15%。疼痛通常是首发症状，可为局部性、夜间发作或放射至手臂和/或肢体。我们报告一例颈胸段脊柱软膜下脂肪瘤的罕见病例并复习当前文献。
一名22岁女性，入院前三个月以四肢轻瘫为主诉就诊。磁共振成像显示颈5至胸4椎体水平存在硬膜内肿瘤。她接受了椎板切除术以完全切除肿瘤。组织病理学检查显示在纤维结缔组织中有成熟脂肪细胞增生。还发现了周围神经纤维和充满红细胞的血管，提示为软膜下纤维脂肪瘤。术后，术后六周肌力有所改善。上肢肌力为5级，下肢肌力为4级。
在该患者中，未使用内固定器械进行了颈胸段椎板切除术和肿瘤切除术。切除病理性病变时的主要目标是完全切除肿瘤。然而，这取决于病变与周围组织的粘连情况。因此，考虑到可能发生的神经并发症，部分肿瘤切除也是可行的。
由于软膜下脂肪瘤罕见，其治疗具有高度专业性。对患者身体状况的评估和影像学评估可为潜在的治疗策略和结果提供信息。
