Intramedullary non-dysraphic spinal cord lipoma

Intramedullary non-dysraphic spinal cord lipoma is an extremely rare benign fatty tumor that develops within the substance of the spinal cord itself, without any associated spinal dysraphism (i.e., without defects in the closure of the neural tube such as spina bifida or myelomeningocele). Unlike the more common lipomas associated with spinal dysraphism, these lesions arise within an otherwise normally formed spinal cord and are not connected to subcutaneous fat or skin abnormalities. They are thought to represent congenital malformations resulting from abnormal differentiation of mesenchymal cells during embryonic development, though the exact etiology remains unclear. The condition primarily affects the central nervous system, specifically the spinal cord. Clinical presentation depends on the location and size of the lipoma within the spinal cord and typically includes progressive myelopathy with symptoms such as motor weakness in the limbs, sensory disturbances (numbness, tingling, or pain), gait difficulties, and in some cases bowel or bladder dysfunction. Symptoms may develop insidiously over months to years as the lipoma slowly enlarges and compresses surrounding neural tissue. The cervical and thoracic segments of the spinal cord are most commonly affected. Diagnosis is established through magnetic resonance imaging (MRI), which characteristically shows a well-defined hyperintense lesion on T1-weighted images within the spinal cord, without contrast enhancement. Treatment is primarily surgical, involving subtotal resection or debulking of the lipoma to decompress the spinal cord and halt neurological deterioration. Complete resection is often not feasible due to the intimate relationship of the lipoma with functional neural tissue. The prognosis following surgery is generally favorable, with stabilization or improvement of neurological symptoms in many patients, though recurrence is possible. There is no established medical therapy for this condition.

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