Spinal angiolipomas

Abstract

Spinal angiolipomas are distinct, benign lesions composed of mature lipocytes admixed with abnormal blood vessels. Three new cases of spinal angiolipoma are presented and 34 previously reported cases are analyzed. The 37 total cases (23 females and 14 males) ranged in age from 17 to 73 years (mean 43 years; median 45 years). The mean age of the female patients was older than that for the males (45.0 vs. 41.6 years; p < 0.001, Student's t-test) and most were peri- or postmenopausal. Prior to diagnosis, 97% of the patients had weakness of the lower extremities, 94% had sensory dysfunction, 84% had hyperreflexia and spasticity, 51% had sphincter dysfunction, and 41% had back pain lasting from 1 to 180 months (mean 28 months). Five (22%) of the 23 female patients were pregnant and two had exhibited significant weight gain coincident with the onset of symptoms. The angiolipomas were extradural in 35 patients and intramedullary in two; seven of the extradural lesions infiltrated the surrounding bone. The tumors extended from C-6 to L-4 and had a predilection for the midthoracic region (53% of cases). Plain radiographs were abnormal in 11 (39%) of 28 patients and in all patients with bone infiltration. Myelograms were abnormal in 97% of 32 patients and showed a complete block in 63% of patients. Computerized tomography (CT) and magnetic resonance (MR) imaging revealed the fat-density lesions in all cases studied. There was vascular enhancement in three of five cases with contrast-infused CT and in the one case with gadolinium-infused MR imaging. All patients improved following resection of the epidural lesions and internal decompression of the intramedullary lesions. It is concluded that spinal angiolipomas predominantly affect women. They involve the thoracic (especially the midthoracic) region, and produce symptoms and signs of spinal compression and, in some cases, bone erosion and pathological fractures. Their symptomatology can be exacerbated by pregnancy and weight gain, suggesting that vascular engorgement and the presence of obesity influence their evolution. Their preponderance in older, peri-, or postmenopausal women, and their clinical exacerbation in pregnant women support a role for hormonal influence. Magnetic resonance imaging is the investigation of choice for the diagnosis of these lesions. Surgery is universally successful in relieving symptoms.

Giant Cervical Lipoma with Cervicomedullary Epidural Extension

“…These lesions are usually associated with spinal dysraphism and located in the dorsal region. Our patient had no evidence of spinal dysraphism, and the absent posterior rim of the foramen magnum was apparently due to progressive erosion by the progressive increase in the size of the lesion over the years [4, 9]. We could not find earlier reports of epidural lipoma in the CM region; however, all other regions have been shown to be involved [3, 4, 6, 7].…”

“…These events are classified as epidural lipomatosis (mostly observed in patients on chronic steroid treatment) or as lipoma, common in spinal dysraphism [1, 3]. There are reports of epidural lipoma and angiolipomas usually in the dorsal region and over the posterior aspect of the dura [4]. Surgical excision is curative and simpler as the lesion can be peeled off from the dura [5].…”

Epidural spinal angiolipoma: a case series

“…In fact, some authors consider SAL in the middle of a disease spectrum with lipoma at one end and hemangioma in the other end [16]. Several predisposing factors were also suggested to be associated with SAL, such as weight gaining or hormonal changes in pregnancy [11] and elevated body mass index [10], however, systematic studies on the etiology of SALS are still lacking.…”

The subdural extramedullary angiolipoma: A rare case report and review of literature

“…The clinical symptom can be exacerbated by pregnancy and obesity. [12] Magnetic resonance imaging is the best way to identify the spinal angiolipoma. Most reported cases revealed predominantly high signal on T1-and T2-weighted images and heterogeneously enhanced after administering the gadolinium because of the presence of interspersed vascular elements.…”