Neuroradiology

Intradural lipoma

the least common form of spinal lipoma (see lipoma CNS), representing less than 1% of primary spinal tumours. They are believed to be embryogenetic in origin and are related to lipomyelo(meningo)cele with which they share a common origin in the separation of the neural from the cutaneous ectoderm during neurolation that allows some mesoderm to gain the dorsal surface of the neural tissue. This mesoderm constitutes the lipoma by transforming into fat tissue; it remains incarcerated in the folding neural tissue in which it prevents complete dorsal fusion but, in distinction to myelo(meningo)cele, does not prevent the dorsal fusion of the dura and of the osseous posterior elements of the spine.

Intradural lipomas occur anywhere in the spine but unlike lipomyelomeningoceles) are most frequent in the cervical and thoracic spine. They occur most frequently in the dorsal portion of the spinal cord but they also lie in a lateral location.

They present most frequently with spinal cord compression syndrome.

The fatty nature of the lesion and the resulting spinal cord compression are easily and best depicted by MR. Associated anomalies include focal enlargement of the spinal canal and of the corresponding neural foramina, vertebral posterior arch schisis and hydro- or syringomyelia that is present in about 2% of cases (Fig.1).

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Fig.1

a. MR, T1-weighted midline sagittal image. Extramedullary intradural mass, located posteriorly to the spinal cord, with a hyperintense component (fat) and an anterior isodense component (fibrous tissue). b. MR, T2-weighted image. Oedema of the compressed cord is well appreciated as extensive intramedullary hyperintensity. c. Following gadolininum injection enhancement of the fibrous component is appreciated (fibrolipoma).
Intradural lipoma, Fig.1 (a)
Intradural lipoma, Fig.1 (b)
Intradural lipoma, Fig.1 (c)