Intradural-Extramedullary Cervical Cord Lipoma: Case Report and Literature Review.

BACKGROUND: Spinal lipomas are generally thought to occur as a result of failed primary neurulation. Failed primary neurulation allows invasion of mesenchymal tissue of mesodermic origin into the neural structure, leading to the formation of a spinal lipoma. Despite most spinal lipomas being regarded as the result of failed primary neurulation, some confusion in terms of the embryogenesis of spinal lipomas remains. Recently, a novel classification of spinal lipomas based on embryonic changes seen during primary and secondary neurulation was has been proposed. CASE DESCRIPTION: We present a case of an intradural-extramedullary spinal cord lipoma, associated with a subjacent subcutaneous lipoma at the cervicothoracic region. The patient presented with worsening neurologic symptoms, indicating ongoing cervical myelopathy. A subtotal resection along with posterior cervical stabilization was achieved, with mild improvement of neurologic symptoms. Clinical, pathologic, and radiologic records are reviewed. CONCLUSIONS: To the best of our knowledge, this is the first described case of a spinal cord lipoma with at such a location, one that cannot be fully categorized within the newly proposed classification system.

Abscess of the medulla oblongata in a toddler: case report and technical considerations based on magnetic resonance imaging tractography.

BACKGROUND AND IMPORTANCE: We report a unique case of a toddler (the only one reported) successfully operated on for a medulla oblongata abscess and comment on the influence of neuroimaging modalities in the preoperative planning of the surgical approach. CLINICAL PRESENTATION: We report a case of a 20-month-old child with a solitary medulla oblongata abscess. The abscess appeared to be in close proximity to the anterior medulla oblongata, but preoperative planning based on diffusion tensor imaging (DTI) tractography motivated us to try to remove this lesion through a midline suboccipital approach. The ventral medulla oblongata abscess was surgically removed via a telovelar approach. At the anterior wall of the 4th ventricle, a fenestration was made with pus release and evacuation of the cavity. The child was discharged 1 week later with an uneventful and full recovery. CONCLUSION: Modern imaging modalities of the nervous system can be very helpful in preoperative planning. Functional visualization of the nervous system provided by modern imaging techniques, such as the DTI tractography, can alter the classic topographic concept of surgical approach. In the case presented, approaching an anterior medulla oblongata abscess based on DTI tractography data, through a suboccipital midline transventricular approach, proved to be an effective and safe technique.