Acute presentations of intradural lipomas: case reports and a review of the literature.

Autor: Massimi L; Pediatric Neurosurgery - Neurosurgery Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy. lmassimi@email.it.; Università Cattolica del Sacro Cuore, Istituto di Neurochirurgia, Roma, Italy. lmassimi@email.it., Feitosa Chaves TM; Departamento de Neurocirurgia Pediátrica, Casa de Saúde Santa Marcelina, Sao Paulo, Brazil., Legninda Sop FY; Pediatric Neurosurgery - Neurosurgery Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy., Frassanito P; Pediatric Neurosurgery - Neurosurgery Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy., Tamburrini G; Pediatric Neurosurgery - Neurosurgery Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy.; Università Cattolica del Sacro Cuore, Istituto di Neurochirurgia, Roma, Italy., Caldarelli M; Pediatric Neurosurgery - Neurosurgery Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy.; Università Cattolica del Sacro Cuore, Istituto di Neurochirurgia, Roma, Italy.
Jazyk: angličtina
Zdroj: BMC neurology [BMC Neurol] 2019 Aug 08; Vol. 19 (1), pp. 189. Date of Electronic Publication: 2019 Aug 08.
DOI: 10.1186/s12883-019-1413-4
Abstrakt: Background: Lumbosacral lipomas (LLs) may remain asymptomatic or lead to progressive neurological deterioration. However, sudden neurological deterioration is a rare and severe event. Herein, we report rare occurrences of sudden clinical deterioration in two previously asymptomatic children harbouring intradural LLs without dermal sinus tracts or signs of occult dysraphism. A review of the pertinent literature is also included.
Case Presentation: One child exhibited acute deterioration because of an epidural abscess associated with a filar lipoma without a sinus tract (probably caused by haematogenous spreading from a respiratory tract multiple infection), and the other child exhibited acute deterioration because of a very large, holocord syringomyelia-like cyst associated with a small conus lipoma. Both patients were 4 years old. In case #2, a previously undetected, severe tethered cord (conus at the S3-S4 level) was also present. A complete recovery was attained after an urgent surgical operation in both cases (in addition to targeted antibiotic therapy in case #1). All cases of deterioration in the literature were caused by abscess formation in dermal sinus tracts.
Conclusions: Prophylactic surgery may be indicated even in asymptomatic children that have tethered cord and surgically favourable LLs (small dorsal and filar LLs), especially if the conditions are associated with progressive syringomyelia. Similarly, intradural dermal sinus tracts should be regarded as surgery-indicated, even if the conus is in its normal position and the patient is asymptomatic because there is a consistent risk of severe, infection-related complications. Finally, asymptomatic patients with filar LLs and a normally located conus can be candidates for surgery or an accurate clinical and radiological follow-up.
Databáze: MEDLINE
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