A 36-year-old woman with a sudden history of low back pain radiating into the right lower extremity. The physical examination revealed paraparesis, saddle anesthesia and urinary incontinence. Magnetic resonance imaging revealed lipoma of the filum terminale (hyperintense sign within the filum terminale) (Figure 1). The patient underwent surgery without delay with intraoperative neurophysiological monitoring (Figure 2), and she had a full recovery of all neurological deficits.
Pre-operative images. T1-weighted magnetic resonance images showing a lipoma of the filum terminale (hyperintense sign within the filum terminale, white arrow) in sagittal (A) and axial (B) planes
Operative findings surgical features: exposure of the dural sac (A), observe the lipoma of the filum terminale (arrow) and after dural sac open (B). Lipoma filum terminale (C), neurophysiological monitoring (D): tracings demonstrating amplitude of the wave and the number of stages before (continuous arrow) and after (dashed arrow). An increase was observed in amplitude of wave number and phase after resection of the lipoma of the filum terminale
Lipoma of the filum terminale is one of the commonest causes of occult spinal dysraphism.11. Finn MA, Walker ML. Spinal lipomas: clinical spectrum, embryology, and treatment. Neurosurg Focus. 2007;23(2):E10. Review. However, only few articles associate lipoma of the filum terminale and neurological deficit.22. Bulsara KR, Zomorodi AR, Villavicencio AT, Fuchs H, George TM. Clinical outcome differences for lipomyelomeningoceles, intraspinal lipomas, and lipomas of the filum terminale. Neurosurg Rev. 2001;24(4):192-4.
REFERENCES
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1Finn MA, Walker ML. Spinal lipomas: clinical spectrum, embryology, and treatment. Neurosurg Focus. 2007;23(2):E10. Review.
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2Bulsara KR, Zomorodi AR, Villavicencio AT, Fuchs H, George TM. Clinical outcome differences for lipomyelomeningoceles, intraspinal lipomas, and lipomas of the filum terminale. Neurosurg Rev. 2001;24(4):192-4.
Publication Dates
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Publication in this collection
Jan-Mar 2017
History
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Received
27 Sept 2016 -
Accepted
9 Jan 2017