Age / Sex : 29 / F

Lipomyelocele

Discussion

Findings:

Low lying tethered spinal cord placode inserting into large lipomatous mass - extending through a dorsal dysraphic defect into the subcutaneous fat, covered with skin

 - Placode/lipoma interface lies within spinal canal

Differential Diagnosis:

Lipomyelomeningocele

Intradural lipoma

Meningocele

Diagnosis:

Lipomyelocele

Discussion:

 Lipomas with a dural defect : lipomyelocele and lipomyelomeningocele

- Spinal lipomas : defective primary neurulation, involving focal premature disjunction of the

cutaneous ectoderm from the neuroectoderm

- Anomalies accounted for 75.9% of spinal lipomas

- Lipomyelocele, more than twice as common as lipomyelomenigocele

- Lipomyelocele

   ⇒ placode–lipoma interface lies within the spinal canal

   ⇒ extend over several vertebral levels.

⇒ continuity of the intraspinal lipoma with the subcutaneous fat through a posterior bony

spina bifida

   ⇒ size of the spinal canal : increased depending on the size of the lipoma

⇒ size of the subarachnoid space ventral to the cord : consistently normal

- Lipomyelomeningocele

⇒ placode–lipoma interface lies outside the anatomic boundaries of the spinal canal

⇒ placode : stretched and rotated eccentrically towards the lipoma on one side, whereas

the meninges herniate on the opposite side

References:

1. Tortori-Donati P, Rossi A, Cama A. Spinal dysraphism: a review of neuroradiological features with embryological correlations and proposal for a new classification. Neuroradiology 2000; 42:471–491. 


2. Rossi A, Biancheri R, Cama A, Piatelli G, Ravegnani M, Tortori-Donati P. Imaging in spine and spinal cord malformations. Eur J Radiol. 2004; 50:177–200 


3. Rufener SL, Ibrahim M, Raybaud CA, Parmar HA. Congenital spine and spinal cord malformations--pictorial review. Am J Roentgenol. 2010;194(3 Suppl):S26-37