Fujimoto M, Odake G, Yano I, Naruse S, Mizukawa N, Saeki Y
No Shinkei Geka. 1978 Dec;6(12):1203-6.
A case of 2-month-old girl with lumbosacral lipomeningocele was reported. She was admitted for evaluation of a large soft mass in the lumbosacral area, initially noted at birth. On examination, the tumor was 7 cm in diameter and 3 cm in height. The upper part of a mass was cystic. Plain X-ray films revealed bifid lower lumbar and sacal vertebra. Spinal CT scans revealed a mass and bifid spine. An area with EMI units, 2.4+/-4.2, at L4 level and another with EMI units, -52.9+/-5.5, at L5 level were seen extending from within the canal to the subcutaneous tissue. The former was identified as water and the latter as fat. The preoperative diagnosis of lipomeningocele was made. Operation was performed under the operating microscope. A meningocele sac contained no neural element and it's surface was adhesive to lipoma. Lipoma involved cauda equina and conus medullaris in the canal. We removed the extraspinal lipoma with meningeal sac and a part of the intraspinal lipoma to avoid neurological deficit. We consider, like many authors, that intraspinal lipoma should be operated as early as possible with the help of surgical microscope. Early diagnosis is necessary. Myelography is valuable but caution is needed at time of lumbar or cisternal puncture. But spinal computed tomography is noninvasive and allows for precise diagnosis without contrast myelography. CT scan is extremely useful in diagnosing congenital abnormality of the spine.
报告了一例2个月大患有腰骶部脂肪瘤型脊膜膨出的女孩。她因腰骶部区域一个出生时就已发现的巨大柔软肿块入院评估。检查发现，肿瘤直径7厘米，高3厘米。肿块上部呈囊性。普通X线片显示下腰椎和骶椎裂。脊柱CT扫描显示有一个肿块和脊柱裂。在L4水平可见一个EMI值为2.4±4.2的区域，在L5水平可见另一个EMI值为 -52.9±5.5的区域，从椎管内延伸至皮下组织。前者被确定为水，后者为脂肪。术前诊断为脂肪瘤型脊膜膨出。在手术显微镜下进行了手术。一个脊膜膨出囊内不含神经成分，其表面与脂肪瘤粘连。脂肪瘤累及椎管内的马尾和脊髓圆锥。我们切除了椎管外带脊膜囊的脂肪瘤以及部分椎管内脂肪瘤，以避免神经功能缺损。我们和许多作者一样认为，椎管内脂肪瘤应在手术显微镜的帮助下尽早进行手术。早期诊断很有必要。脊髓造影很有价值，但在进行腰椎或脑池穿刺时需要谨慎。但脊柱计算机断层扫描是非侵入性的，无需脊髓造影剂就能进行精确诊断。CT扫描在诊断脊柱先天性异常方面极其有用。
