Blood blister aneuryms are uncommon lesions that have a poor natural history. Because there is no clear aneurysmal sac to treat they remain challenging lesions to manage whether the approach is endovascular or surgical. Although the management of intracranial cerebral aneurysms has changed subsequent to the results published by the ISAT trial, there still exist groups of aneurysms which do not lend themselves to endovascular management. There are recent reports of successful endovascular management using flow diverting approaches but experience is limited and relying on flow change may be insufficient to prevent re-rupture. Surgery when possible offers the advantage of immediate vessel wall reconstruction.
Intradural cervical lipomas with intracranial extension are very rare. There have been 12 previously reported cases. We report an 18-year-old female who presented with quadraparesis and incontinence, and review the previously published literature. Intradural lipomas with intracranial extension occur in younger patients when compared with those without intracranial extension. Roughly half of high cervical lipomas have intracranial extension. This results in a more complicated course of surgical management and a worse prognosis. While the relatively older patients most commonly present with quadriplegia, in younger patients there may be a more variable presentation. Almost half the patients had symptoms ascribable to the intracranial component. In all patients, no more than subtotal resection and decompression was achieved using duroplasty if necessary. Only five patients showed functional recovery. We propose a management strategy for this condition.
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