Non-dysraphic intramedullary lipoma of the cervical spine: A systematic review of management strategies and outcomes.

BACKGROUND: Non-dysraphic intramedullary lipomas of the cervical spine are extremely rare, and only few cases have been reported. We aimed to provide a thorough review of the literature regarding patient characteristics, treatment options, and outcomes in these patients. We also provided an illustrative case from our institution which we added to the pool of patients identified by our review. METHODS: Using the PRISMA guidelines, the literature in PubMed/Medline, Web of Science, and Scopus databases was searched. Nineteen studies were included in the final quantitative analysis. The Joanna Briggs Institute critical appraisal tool was used to assess the risk of bias. RESULTS: We identified 24 patients with non-dysraphic cervical intradural intramedullary lipoma of the spinal cord. The patients were predominantly male (70.8%) with a mean age of 30.3 years. Quadriparesis was observed in 33.3% of the cases, while paraparesis in 25% of the patients. Sensory disturbances were observed in 8.3% of the cases. In some patients, the presenting symptoms were neck pain (4.2%) and headache (4.2%). Surgical treatment was performed in 22 cases (91.7%). In 13 cases (54.2%) a subtotal removal was reached, and in 8 (33,3%) partial tumor removal was feasible. In 1 case (4.2%) a simple laminectomy was performed. Fourteen patients (58.3%) improved, 6 (25%) were unvaried, while 2 (8.3%) worsened. The mean follow-up was 30.8 months. CONCLUSIONS: Overall, surgical treatment can provide substantial spinal cord decompression improving or stabilizing the neurological deficits. Experience from our case, along with the analysis of reports from the literature, suggest that careful and controlled resection may provide benefit and avoid serious complications otherwise given by an aggressive resection.