• Kai-Yuan Chen, Joseph Osorio, Joshua Rivera, and Dean Chou.
• Department of Neurological Surgery, University of California, San Francisco, California, USA; Department of Neurosurgery, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Surgery, Taichung Veterans General Hospital Puli Branch, Nantou, Taiwan. Electronic address: kaiyuan.chen419@gmail.com.
• World Neurosurg. 2019 Jan 1; 121: 156-159.

BackgroundIntradural intramedullary lipomas without dysraphism are rare tumors. Although they appear extramedullary on imaging, they invade into the intramedullary substance of the spinal cord. We present 2 cases and discuss their clinical presentation, radiologic findings, and surgical management.Case DescriptionCase 1 is a 21-year-old woman who presented with upper back pain from recurrent lipoma. She had undergone partial excision in 2008 at an outside hospital. Physical examination revealed full strength but hyperreflexia in the legs. Magnetic resonance imaging (MRI) revealed a recurrent thoracic spinal tumor with spinal cord compression. Surgery was performed, and it was found that the tumor was both extramedullary and intramedullary, with an obscure delineation between tumor and cord. Subtotal excision was performed, and the patient remained neurologically intact. Case 2 is a 47-year-old woman who presented with leg weakness, difficulty in walking, and foot drop. Physical examination revealed 4/5 in the lower extremities. MRI demonstrated a spinal lipoma with thoracic cord compression. Even though the tumor appeared to be an extramedullary lesion by MRI, intraoperatively, the tumor became intramedullary with loss of distinction between the spinal cord and tumor. Subtotal excision was performed, and the patient regained her strength to 5/5 postoperatively.ConclusionsIntramedullary thoracic spinal lipomas without spinal dysraphism are rare. Although these tumors may appear completely extramedullary on imaging, extreme care should be taken during surgery because the lesions eventually become intramedullary, intercalating within the substance of the spinal cord, precluding gross total resection.Copyright © 2018 Elsevier Inc. All rights reserved.

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