Lipoma cauda equina

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3 types of fat in the spinal intradural space

  1. spinal cord lipomas – fat within the normally positioned spinal cord which is unassociated with cutaneous or bony congenital anomalies; most commonly situated dorsally in the thoracic spinal cord and present in adulthood more commonly in males
    1. multipotential mesodermal cells incorporated into the infolding neural tube thought to be the origin or spinal cord lipomas with aberrant development on day 18 through 27 of gestation
    2. goal of surgery is substantial debulking of the lipoma since there is normally not a cleavage plane
  2. lipomyelomeningocele – congenital lesion associated with spina bifida; fat within a dysmorphic conus medullaris
    1. almost always an overlying cutaneous abnormality with a female predominance
    2. aberrant embryology thought to occur between days 28 through 48 of gestation (NOTE: lipomyelomeningoceles occur later in development than lipomas)
    3. usually have soft tissue swelling over the spine (90% of the time) and/or dermal sinus tract, atretic meningocele, hemangioma and focal hirsutism in 50%
    4. may present with progressive asymmetrical foot deformities or foot length discrepancies and atrophic ulcerations of the skin of the feet
    5. may have signs of both upper and lower motor neuron disturbances in the same extremity
    6. usually have dorsal fusion defect in the lamina (i.e. spina bifida) and have abnormal plain films
    7. prophylactic surgery is recommended since there is such a strong likelihood of worsening
    8. surgically there are two types of lipomyelomenigoceles
      1. dorsal – lesion is located dorsally though a fascial, bony and dural defect; all nerve roots emerge from the ventral or lateral surface of the neural tissue and lie in the subarachnoid space, more lateral are sensory and more medial are motor
      2. caudal – lipoma exits the area of the filum terminale so that the cord simply becomes progressively larger caudally and the nerve roots transgress the lipoma but most are thought to be nonfunctional so they can be sectioned after stimulation
  3. fat within the filum terminale
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