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  • Updated 09.01.2020
  • Released 12.10.1997
  • Expires For CME 09.01.2023

Lipomas of the nervous system

Introduction

Overview

Intracranial and intraspinal lipomas are congenital or developmental in origin and are not true neoplasms. They occur throughout the neuroaxis but are most commonly found in or near the midline. Most intracranial lipomas are identified incidentally and do not grow over time. Some are associated with midline facial and palatal abnormalities in conjunction with agenesis of the corpus callosum. Cerebral lipomas may result in focal disturbances in cerebral cortical development and epilepsy. Spinal lipomas generally affect the lumbosacral spine and may cause symptoms due to spinal cord tethering. Surgical intervention is recommended for symptomatic spinal cord lipomas. Surgical indications for asymptomatic spinal cord lipomas remain a topic of active debate. In this article, we review the diagnosis, complications, and indications for intervention in intraspinal and intracranial lipomas.

Key points

• Lipomas are most commonly found in the midline and are frequently asymptomatic.

• Lipomas may be associated with additional dystrophic and congenital malformations.

• Most lipomas grow very slowly or not at all, and conservative management is advised in the absence of symptoms and signs.

• Surgery on intracranial lipomas does not usually improve seizure control.

• In symptomatic filum terminale lipomas, early surgery may improve symptoms for many years.

• Surgery for symptomatic lipomas involving brain, brainstem, cerebellopontine angle, and cervicothoracic cord are equally as likely to further deteriorate as to improve.

Historical note and terminology

Intracranial and intraspinal lipomas are congenital or developmental in origin and are not true neoplasms. The first probable description of an intracranial lipoma can be attributed to Meckel in 1818, who described a lipoma of the optic chiasm. Several years later, Rokitansky described the pathology of a lipoma of the corpus callosum (38). Various classification schemes have been proposed. In 1985, Mori classified central nervous system lipomas pathologically and embryologically into 4 groups (26). A classification system for congenital spinal lipomas was devised by Muthukumar based on whether or not a dural defect was present (30). A classification of spinal lipomas based on embryologic stage has been proposed (27).

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