Skip to main content
SpringerLink
Log in

Congenital spinal lipomatous malformations

Part I—classification

  • Clinical Article
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Background

Congenital spinal lipomatous malformations constitute a diverse group of lesions. There is considerable confusion in the literature regarding their terminology and a proper classification is long overdue. The first part of this two part report sets out a proposed classification scheme.

Methods

On the basis of this author’s experience with 80 patients with a congenital spinal lipomatous malformation treated over a 10 year period, a new classification is proposed. The proposed classification divides congenital spinal lipomatous malformations into two broad groups: 1. Lipomas without dural defect and, 2. Lipomas with dural defect. Within each group, there are several subtypes. These two broad groups differ from one another in their embryology, clinical presentation, operative findings, complications and prognosis

Findings

Group I consists of Lipomas without dural defect. Included in this group are : Filum lipoma, caudal lipoma without dural defect, and intramedullary lipoma. Group II consists of lipomas with dural defect. Included in this group are : dorsal lipoma, caudal lipoma with dural defect, transitional lipoma, lipomyelocele, and lipomyelomeningocele. The definitions of the various subtypes and radiological and operative findings of all these lesions are described.

Conclusions

Congenital spinal lipomatous malformations constitute a wide spectrum of lesions ranging from relatively simple lipomas of the filum terminale to complex malformations. These lesions differ from one another in their embryology, clinical presentation, operative strategies, complications and prognosis. Failure to differentiate between the different forms of congenital spinal lipomatous malformations may lead to inaccurate assumptions regarding prognosis and inappropriate management. The proposed classification seeks to address these issues.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9

Similar content being viewed by others

References

  1. Arai H, Sato K, Okuda O, Miyajima M, Hishi M, Nakanishi H, Ishii H (2001) Surgical experience of 120 patients with lumbosacral lipomas. Acta Neurochir (Wien) 143:857–864, doi:10.1007/s007010170015

    Article  CAS  Google Scholar 

  2. Bassett RCL (1950) The neurological deficit associated with lipomas of the cauda equine. Ann Surg 13:109–116, doi:10.1097/00000658-195001000-00012

    Article  Google Scholar 

  3. Blount JP, Elton S (2001) Spinal lipomas. Neurosurg Focus 10(1):1–13, doi:10.3171/foc.2001.10.1.4

    Article  Google Scholar 

  4. Bodelier AG, Groeneveld W, van der Linden AN, Haak HR (2004) Symptomatic epidural lipomatosis in ectopic Cushing’s syndrome. Eur J Endocrinol 151:765–769, doi:10.1530/eje.0.1510765

    Article  PubMed  CAS  Google Scholar 

  5. Bulsara KR, Zomorodi AR, Villavicencio AT, Fuchs H, George TM (2001) Clinical outcome differences for lipomyelomeningoceles, intraspinal lipoma, and lipomas of the filum terminale. Neurosurg Rev 24:192–194, doi:10.1007/s101430100177

    Article  PubMed  CAS  Google Scholar 

  6. Byrne RW, Hayes EA, George TM, McLone DG (1995) Operative resection of 100 spinal lipomas in infants less than 1 year of age. Pediatr Neurosurg 23:182–186, doi:10.1159/000120956

    Article  PubMed  CAS  Google Scholar 

  7. Calenbergh FV, Vanvolsem S, Verpoorten C, Lagae L, Casaer P, Plets C (1999) Results of surgery for lumbosacral lipoma: the significance of early and late worsening. Childs Nerv Syst 15:439–443

    Article  PubMed  Google Scholar 

  8. Chapman PH (1982) Congential intraspinal lipomas. Anatomic considerations and surgical treatment. Childs Brain 9:37–47, doi:10.1159/000120033

    Article  PubMed  CAS  Google Scholar 

  9. Chapman PH (2004) Comment. Neurosurgery 54:873–874

    Google Scholar 

  10. Chapman PH, Davis KR (1983) Surgical treatment of spinal lipomas in childhood. In: Raimondi AJ (ed) Concepts in pediatric neurosurgery 3. Karger, Basel, pp 178–190

    Google Scholar 

  11. Chapman PH, Steig PE, Magge S, Bames P, Feany M (1999) Spinal lipoma controversy. Neurosurgery 44:186–193, doi:10.1097/00006123-199901000-00113

    Article  PubMed  CAS  Google Scholar 

  12. Cochrane DD, Finley C, Kestle J, Steinbok P (2000) The patterns of late deterioration in patients with transitional lipomyelomeningocele. Eur J Pediatr Surg 10(Suppl):13–17, doi:10.1055/s-2008-1072406

    Article  PubMed  Google Scholar 

  13. Dorward NL, Scatliff JH, Hayward RD (2002) Congential lumbosacral lipomas: pitfalls in analyzing the results of prophylactic surgery. Childs Nerv Syst 18:326–332, doi:10.1007/s00381-002-0624-x

    Article  PubMed  Google Scholar 

  14. Emery JC, Lenden RG (1969) Lipomas of the cauda equine and other fatty tumors related to neurospinal dysraphism. Dev Med Child Neurol 20:62–70

    CAS  Google Scholar 

  15. Fassett DR, Schmidt MH (2004) Spinal epidural lipomatosis: a review of its causes and recommendations for treatment. Neurosurg Focus 16(4):E11

    PubMed  Google Scholar 

  16. Fogel GR, Cunningham PY 3rd, Esses SI (2005) Spinal epidural lipomatosis: case reports, literature review and meta-analysis. Spine J 5:202–211, doi:10.1016/j.spinee.2004.05.252

    Article  PubMed  Google Scholar 

  17. Forrester MB, Merz RD (2004) Descriptive epidemiology of lipomyelomeningocele, Hawaii, 1986–2001. Birth Defects Res A Clin Mol Teratol 70:953–956, doi:10.1002/bdra.20092

    Article  PubMed  CAS  Google Scholar 

  18. French BN (1982) Embryology of spinal dysraphism. Clin Neurosurg 30:295–340

    Google Scholar 

  19. French BN (1990) Midline fusion defects and defects of formation. In: Youmans JR (ed) Neurological Surgery, vol2. 3rd edn. WB Saunders, Philadelphia, pp 1081–1235

    Google Scholar 

  20. Harrison MJ, Mitnick RJ, Rosenblum BR, Rothman AS (1990) Leptomyelolipoma: analysis of 20 cases. J Neurosurg 73:360–367

    PubMed  CAS  Google Scholar 

  21. Hoffman HJ, Taecholarn C, Hendrick EB, Humphreys RP (1985) Management of lipomyelomeningoceles. Experience at the Hospital for Sick Children. Toronto. J Neurosurg 62:1–8

    Article  PubMed  CAS  Google Scholar 

  22. Ingraham FD, Swan H, Hamlin H, Lowrey JJ, Matson DD, Scott HW Jr (1943) Spina bifida and cranium bifidum. Harvard University Press, Cambridge

    Google Scholar 

  23. James HE, Williams J, Brock W, Kaplan GW, Sang HU (1984) Radical removalof lipomas of the conus and cauda equine with laser microneurosurgery. Neurosurgery 15:340–343

    PubMed  CAS  Google Scholar 

  24. Kanev PM, Bierbrauer KS (1995) Reflections on the natural history of lipomyelomeningocele. Pediatr Neurosurg 22:137–140, doi:10.1159/000120891

    Article  PubMed  CAS  Google Scholar 

  25. Kanev PM, Lemire RJ, Loeser JD, Berger MS (1990) Manangement and long-term follow-up review of children with lipomyelomeningocele, 1952–1987. J Neurosurg 73:48–52

    PubMed  CAS  Google Scholar 

  26. Kang JK, Lee KS, Jeun SS, Lee IW, Kim MC (2003) Role of surgery for maintaining urological function and prevention of retethering in the treatment of lipomyelomeningocele: experience recorded in 75 lipomyelomeningocele patients. Childs Nerv Syst 19:23–29

    PubMed  Google Scholar 

  27. Kotilainen E, Hohenthal U, Karhu J, Kotilainen P (2006) Spinal epidural lipomatosis caused by corticosteroid treatment in ulcerative colitis. Eur J Intern Med 17:138–140, doi:10.1016/j.ejim.2005.08.011

    Article  PubMed  Google Scholar 

  28. Koyanagi I, Iwasaki Y, Hida K, Abe H, Isu T, Akino M, Aida T (2000) Factors in neurological deterioration and the role of surgical treatment in lumbosacral lipoma. Childs Nerv Syst 16:143–149, doi:10.1007/s003810050481

    Article  PubMed  CAS  Google Scholar 

  29. Kulkarni AV, Pierre-Kahn A, Zerah M (2004) Conservative management of asymptomatic lipomas of the conus. Neurosurgery 54:868–875, doi:10.1227/01.NEU.0000114923.76542.81

    Article  PubMed  Google Scholar 

  30. La Marca F, Grant JA, Tomita T, McLone DG (1997) Spinal lipomas in children: outcome of 270 procedures. Pediatr Neurosurg 26:8–16, doi:10.1159/000121155

    Article  PubMed  Google Scholar 

  31. Lassman LP, James CC (1967) Lumbosacral lipomas: critical survey of 26 cases submitted to laminectomy. J Neurol Neurosurg Psychiatry 30:174–181, doi:10.1136/jnnp.30.2.174

    Article  PubMed  CAS  Google Scholar 

  32. Li YC, Shin SH, Cho BK, Lee MS, Lee YJ, Hong SK, Wang KC (2001) Pathogenesis of lumbosacral lipoma: a test of the “premature dysjunction” theory. Pediatr Neurosurg 34:124–130 doi:10.1159/000056007

    Article  PubMed  CAS  Google Scholar 

  33. McComb GJ (1999) Neurosurgery 44:192–193, Comment doi:10.1097/00006123-199901000-00114

    Article  Google Scholar 

  34. McComb GJ (2004) Comment. Neurosurgery 54:875

    Google Scholar 

  35. McLone DG, Mutluer S, Naidich TP (1982) Lipomeningoceles of the conus medullaris, in concepts in pediatric neurosurgery. vol. 3. S. Karger, Basel, pp 171–177

  36. McLone DG, Nadich TP (1986) Laser resection of fifty spinal lipomas. Neurosurgery 18:611–615, doi:10.1097/00006123-198605000-00016

    Article  PubMed  CAS  Google Scholar 

  37. McNeely PD, Howes WJ (2004) Ineffectiveness of dietary folic acid supplementation on the incidence of lipomyelomeningocele: pathogenetic implications. J Neurosurg 100(2 Suppl Pediatrics):98–100

    PubMed  CAS  Google Scholar 

  38. Morimoto K, Takemoto O, Wakayama A (2005) Spinal lipomas in children—surgical management and long-term follow-up. Pediatr Neurosurg 41:84–87

    Article  PubMed  Google Scholar 

  39. Muthakumar (2009) Congenital Spinal Lipomatous Malformations : Part II. Clinical Presentation, Operative Findings, and Outcome. Acta Neurochir Issue No: Page No

  40. Pierre-Kahn A, Zerah M, Renier D, Cinnalli G, Sainte-Rose C, Lellouch-Tubiana A, Brunelle F, Le Merrer M, Giudicelli Y, Pichon J, Kleinkencht B, Nataf F (1997) Congenital lumbosacral lipomas. Childs Nerv Syst 13:298–335, doi:10.1007/s003810050090

    Article  PubMed  CAS  Google Scholar 

  41. Sandberg DI, Lavyne MH (1999) Symptomatic spinal epidural lipomatosis after local epidural corticosteroid injections: case report. Neurosurgery 45:162–165, doi:10.1097/00006123-199907000-00037

    Article  PubMed  CAS  Google Scholar 

  42. Schut L, Bruce DA, Sutton LN (1982) The management of the child with lipomyelomeningocele. Clin Neurosurg 30:464–476

    Google Scholar 

  43. Sutton LN (1995) Lipomyelomeningocele. Neurosurg Clin N Am 6:325–338

    PubMed  CAS  Google Scholar 

  44. Till K (1968) Spinal dysraphisms, a study of congenital malformations of the back. Dev Med Child Neurol 10:470

    Article  PubMed  CAS  Google Scholar 

  45. Tortori-Donati P, Rossi A, Cama A (2000) Spinal dysraphism: a review of neuroradiological features with embryological correlations and proposal for a new classification. Neuroradiology 42:471–491, doi:10.1007/s002340000325

    Article  PubMed  CAS  Google Scholar 

  46. Tubbs SR, Naftel RP, Rice WC, Liechty P, Conklin M, Oakes JW (2006) The patient with symptoms following resection of a lipomyelomeningocele: do increases in the lumbosacral angle indicate a tethered spinal cord? J Neurosurg (1 suppl). Pediatrics 105:62–64

    Article  Google Scholar 

  47. Van Calenbergh F, Vanvolaem S, Verpoorten C, Lagae L, Casaer P, Plets C (1999) Results after surgery for lumbosacral lipoma: the significance of early and late worsening. Childs Nerv Syst 15:439–442, doi:10.1007/s003810050433

    Article  PubMed  Google Scholar 

  48. Xenos C, Sgouros S, Walsh R, Hockley A (2000) Spinal lipomas in children. Pediatr Neurosurg 32:295–307, doi:10.1159/000028958

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Madurai Medical College, Madurai, India

    Natarajan Muthukumar

  2. Muruganagam, 138, Anna Nagar, Madurai, 625 020, India

    Natarajan Muthukumar

Authors
  1. Natarajan Muthukumar
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Natarajan Muthukumar.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Muthukumar, N. Congenital spinal lipomatous malformations. Acta Neurochir (Wien) 151, 179–188 (2009). https://doi.org/10.1007/s00701-009-0208-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00701-009-0208-6

Keywords

Search

Navigation