• Journal of Korean Neurosurgical Society
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• v.41 no.5
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• pp.330-332
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• 2007

Intracranial lipomas are rare, and most of these tumors are found in the region of the corpus callosum, followed by cerebellopontine angle. We present a case of a intracranial lipoma in 30-year-old man. Brain computed tomography [CT] scan and magnetic resonance images [MRI] showed a mass in the medulla oblongata extending to foramen magnum. The histopathologically, diagnosis of lipoma was confirmed. Although there were several cases of cervical intraspinal lipoma extending into posterior cranial fossa, there have been no previous reports of a lipoma arising from the medulla oblongata that extended into the foramen magnum. We describe a rare case of intradural subpial lipoma in the medulla oblongata with a review of the literature.

• Journal of Korean Neurosurgical Society
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• v.38 no.4
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• pp.316-319
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• 2005

A 42-year-old female was admitted with an 11-month history of progressive spastic paraparesis and ataxic gait. Magnetic resonance imaging showed intraspinal space occupying lesion compressing the spinal cord posteriorly, located from C5 to T2 with iso to high signal intensity at T2-weighted images and high signal intensity at T1-weighted images. The patient underwent surgery for decompression of the affected spinal cord because of the progressive neurological deficit. At surgery, the lesion was intradural extramedullary lipoma composed with mature adipose tissue. Partial tumor removal to decompress the neural structures and laminoplasty to avoid postoperative instability and deformity were performed. Postoperatively, she demonstrated improvement in paraparesis and was able to walk without assistance. Though attempts to decrease the size of or even to totally remove a lipoma are not required to achieve satisfactory results and carry considerable risks of surgical morbidity, a careful and limited decompression of the affected spinal cord through a partial removal of the tumor and laminoplasty could result in a significant neurological improvement.

• Journal of Korean Neurosurgical Society
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• v.46 no.5
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• pp.468-471
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• 2009

Objective : The adolescent presentation of tethered cord syndrome (TCS) is well-recognized, but continues to pose significant diagnostic and management controversies. The authors conducted a retrospective study of clinical outcomes after surgical intervention in 24 school-aged children, adolescents, and young adults with TCS. Methods : All 83 patients with a lipomyelomeningocele (LMMC) underwent untethering surgery for caudal cord tethering between 1987 and 2007. The clinical charts and follow-up data were reviewed. Of these patients, 24 school-aged children, adolescents, and young adults with TCS were studied with respect to the clinical, radiologic, pathologic features, and surgical outcomes. Results : Untethering procedures were performed in 24 patients (age range, 7-25 years) for TCS of various origins (lipoma, lipomyelomeningocele, and tight filum terminale). Specific circumstances involving additional tugging of the already tight conus, and direct trauma to the back precipitated the onset of symptom in 50% of the patients. Diffuse and non-dermatomal leg pain, often referred to the anorectal region, was the most common presenting symptom. Progressive sensorimotor deficits in the lower extremities, as well as bladder and bowel dysfunction, were also common findings, but progressive foot and spinal deformities were noted less frequently. The most common tethered lesions were intradural lipomas, thickened filum and fibrous band adhesions into the placode sac. The surgical outcome was gratifying in relation to pain and motor weakness, but disappointing with respect to resolution of bowel and bladder dysfunction. Of the 24 patients with TCS, pre-operative deficits improved after surgery in 14 (58.3%). remained stable in 8 (33.4%). and worsened in 2 (8.3%). Conclusion : The pathologic lesions of tethered cord syndrome in school-aged children, adolescents, and young adults, are mostly intradural lipomas and tight filum. It is suggested that the degree of cord traction results in neurologic dysfunction in late life due to abnormal tension, aggravated by trauma or repeated tugging of the conus during exercise. Early diagnosis and adequate surgical release might be the keys to the successful outcome in school-aged children, adolescents, and young adults with TCS.