Cervicothoracic Non-dysraphism Intradural Lipoma: A Case Report and Surgical Outcome

Abstract

Background:

Cervicothoracic non-dysraphic intradural lipomas are rare benign spinal tumors that can cause progressive neurological deficits due to spinal cord and nerve root compression. These tumors are challenging to manage due to their dense adhesion to critical neural structures, which often renders complete excision unfeasible. This case demonstrates that subtotal resection can effectively balance symptomatic relief and preservation of neurological function.

Case presentation:

A 24-year-old male presented with a 2-month history of progressive neck pain, hand numbness, and limb weakness. Magnetic resonance imaging (MRI) revealed a cervicothoracic intradural lipoma causing significant spinal cord compression without intramedullary signal changes, suggesting reversible compression. Posterior decompression and subtotal resection were performed using a surgical microscope. The tumor, pale yellow and soft, was adherent to the spinal cord and nerve roots, necessitating the deliberate decision to leave a small residual portion to minimize neurological risks.

Postoperatively, the patient demonstrated marked neurological improvement, including reduced pain, resolution of numbness, and full recovery of muscle strength. A follow-up at 20 days confirmed clinical improvement, with MRI showing substantial reduction in spinal cord compression.

Conclusions:

Subtotal resection is a safe and effective surgical approach for managing symptomatic cervicothoracic intradural lipomas, particularly when complete excision poses significant risks. This approach allows for significant symptom relief while preserving neurological function. The absence of intramedullary signal changes on preoperative MRI served as a favorable prognostic factor, indicating reversible spinal cord compression. Long-term follow-up is crucial to monitor residual tumor growth and ensure sustained clinical stability. This case highlights the importance of individualized surgical planning and cautious intraoperative decision-making to achieve optimal outcomes.