Intradural lipomas (IL) not associated with spina bifida in the lumbar region are rare and isolated cases have been reported in the literature. The current paper presents a case of a patient who suffers from intradural lipoma without spinal dysraphism in the lumbar region. We also made a brief literature review.
A 31-year-old patient suffered from back pain resistant to medication for more than a year. Few weeks prior to hospitalization, the pain irradiated to the feet associated with numbness, weakness and urinary dysfunction. Upon hospitalization, partial cauda equina syndrome was diagnosed that included radiculopathy along L4-S1 nerve roots, predominantly on the left side, decreased tendon reflexes, left-sided fibular and tibial paresis. Partial urinary retention was also present. Magnetic resonance tomography demonstrated a lesion located in the dorsal intradural space at the level of L3–L4 vertebra that had fat-equivalent ovoid form compressing and dislocating the components of the dural sac ventrally. Laminectomy of L3 and L4 vertebrae was performed. We encountered an intradural tumor formation with a yellowish colour and that was adherent to the nerve roots of cauda equina. After microsurgical dissection of the nerve roots, the tumor was partially resected. The histological examination confirmed the diagnosis of lipoma. Postoperatively, the neurological status improved significantly. The pain syndrome, motor symptoms and pelvic reservoir dysfunction were reduced.
In cases with intradural lipomas, the earliest possible surgical decompression with maximal safe resection of the lesion is a therapeutic method of choice that results in significant improvement or complete recovery of the neurological deficit.