Surgical management of non-dysraphic cervical intramedullary lipoma: A report of two cases

Background: Intradural spinal lipomas without an associated dysraphism, represent a fraction of an already-rare entity. These lesions often present with progressive neurologic deficits. The underlying pathophysiology of these lesions is poorly understood as are the underlying factors that predispose these masses to grow. Case description: We present two cases: an 11-year-old female and a 56-year-old female, each with a cervical spinal intramedullary lipoma presenting with slowly worsening neurological deficits. Each of these lesions were microsurgically debulked and underwent a duraplasty with an Alloderm® patch (Allergan) with rapidly improving symptoms postoperatively. Conclusions: Subpial lipomas, without associated spinal dysraphism, are a rare entity, and both its pathogenesis and the techniques used in management remain uncertain. In our patients, resection of the lipoma with exposure of the lipoma spinal cord interface was performed to a variable degree, while respecting the transiting nerve roots and spinal cord anatomy, with immediate postoperative improvement in function. This reaffirms the benefit of mass reduction and supports a limited decompression. Even the use of a duraplasty to decompress the spinal cord and restore the spinal CSF circulation can greatly impact the postoperative course. Our patients support the relationship between hormonal flux, weight gain, and the onset of symptoms.