Case Report
Non-dysraphic intramedullary lipoma of the craniocervical region in an adult: Case report
Lipoma intramedular no disráfico de la región craneocervical en un adulto: informe de un caso
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the literature" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "243" "paginaFinal" => "249" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Hipertensión intracraneal causada por estenosis del seno sagital superior secundaria a fractura por hundimiento craneal: caso clínico y revisión de la literatura" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 497 "Ancho" => 1250 "Tamanyo" => 120467 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara 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array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Department of Neurosurgery, Apex Cerrahi Tıp Merkezi, İstanbul, Turkey" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Neurosurgery, Harran Üniversity, Şanlıurfa, Turkey" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Lipoma intramedular no disráfico de la región craneocervical en un adulto: informe de un caso" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 944 "Ancho" => 1267 "Tamanyo" => 262682 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Intraoperative view of the lipoma after durotomy.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Lipomas of the spinal cord usually occur in the lumbosacral region and are often associated with spinal dysraphism. Non-dysraphic intradural intramedullary lipomas are very rare, but most prevalent in the cervicothoracic region.<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">1–3</span></a> In very few cases, intramedullary cervical lipomas present with intracranial extension.<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">4–9</span></a> In this report, we present a case of non-dysraphic craniocervical intradural intramedullary lipoma in an adult patient.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Case report</span><p id="par0010" class="elsevierStylePara elsevierViewall">A 28-year-old male was admitted to the hospital with the complaints of progressive weakness, for 3 months, as well as numbness and paresthesia associated with neck stiffness. in both the upper extremities.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Physical examination was unremarkable, and neurological examination revealed spastic quadriparesis, bilateral Babinski reflexes, and clonus signs. Hyperreflexia was observed in all the extremities. He did not have sensory level and gait disturbance.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Computed tomography of the cervical spine showed a hypodense lesion located posterior to the high cervical cord and extending into the posterior fossa (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Magnetic resonance imaging (MRI) showed a hyperintense lesion on T1-weighted images, suggesting lipoma. The lesion compressed the high cervical spinal cord and filled the cisterna magna (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Surgery was performed with the patient in a sitting position with intraoperative neurophysiological monitoring. Suboccipital craniotomy and C1–C3 laminectomy were performed. Following the opening of the dura, a yellowish lipoma was observed (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>), and the lower tip of the encapsulated exophytic intramedullary lipoma was located. The exophytic part of the lipoma was resected using a bipolar coagulator and micro scissors under an operating microscope (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>). Following the resection, the remainder of the lesion was thinned using an ultrasonic surgical aspirator. A thin sheet of the lipoma adhered to the neural tissue on the tumor bed. Although the patient showed no significant improvement from the preoperative motor deficits, after the surgery, the postoperative recovery was uneventful. The histopathological diagnosis was lipoma. A regrowth of the lesion adherent to the brainstem was detected during a follow-up examination 2 years after the surgery. However, at the last follow-up examination conducted 8 years after the surgery, the lipoma remained stable and the motor deficits of the patient showed a slight improvement (<a class="elsevierStyleCrossRef" href="#fig0025">Fig. 5</a>).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><elsevierMultimedia ident="fig0025"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0030" class="elsevierStylePara elsevierViewall">Spinal cord lipomas are rare tumors and account for <1% of all spinal tumors; however, they are the most common tumors of dysembryogenic origin.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">1</span></a> Microscopically, a lipoma comprises mature adipocytes arranged in fibrous connective tissues without atypical features. Non-dysraphic spinal lipomas are accepted as true neoplasms, whereas dysraphic lesions are considered hamartomas.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">10</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The etiology of spinal cord lipomas remains controversial.<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">1,7</span></a> The most common hypothesis is that dysraphic spinal lipomas are caused by the migration of mesenchymal stem cells, which are precursors to adipocytes, into the neural tube before proper closure. However, the presence of intact meninges and posterior spinal elements in non-dysraphic lipomas suggests different cause.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Craniocervical non-dysraphic intradural lipomas are extremely rare and are frequently encountered in childhood.<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">4–9,11–14</span></a> Only a few adult cases have been reported till date,<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">7,8,15,16</span></a><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> summarizes the reported adult cases of these rare lesions. Although lipomas are benign lesions, they can compress the spinal cord and brainstem. During infancy and early childhood, patients present with tetraplegia or floppy baby syndrome, which is attributed to birth injury.<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">13,14</span></a> During adulthood, slowly progressive quadriparesis, accompanied by pain and dysesthetic sensory changes, is the major symptom. Neurological deficit can remain static for several years, and acute neurological deterioration is rare. Despite the intracranial involvement of the lesion, cranial nerve deficits and apnea are rarely observed.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">MRI is very useful in determining the nature and exact location of the lesion.<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">1,9</span></a> Lipomas appear as hyperintense lesions posteriorly-located lesions in the spinal canal on T1-weighted images. While fat is hypointense on T2-weighted images, fat suppression MRI sequences can be essential for the differential diagnosis from hemorrhage and calcified mass.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Spinal lipomas discovered incidentally may be observed because of the benign nature and indolent course of the lesion. However, most cases manifest with major neurological deficits and serious neural tissue compression, which are detected by radiology at the time of diagnosis.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Radical surgical excision usually causes a high rate of morbidity because of the firm adherence between the lipoma and neural tissues and the absence of a true surgical plane.<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">1,9</span></a> Therefore, subtotal excision and neural decompression are often considered the best options.<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">5,7,8</span></a> The operative results for craniocervical lipomas are often unsatisfactory, with a <50% rate of functional improvement.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">9</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Surgical strategy depends on the true location of the lipoma. Although lipomas located in the posterior aspect of the spinal cord have been reported in 50% of the cases, lesions that are solely intramedullary require myelotomy.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">9</span></a> Exophytic intramedullary lipomas have a large dorsal component covered with the pia mater and are called subpial.<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">17,18</span></a> These lesions have a fine membranous capsule, continuous with the pia mater of the spinal cord, and they are immediately observed after durotomy during the surgery. The proximal and distal poles of the exophytic lipomas can be separated from the cord.<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">14,17</span></a> The mass should be resected, leaving a sheet of the lipoma on the tumor bed. Following the resection, the sheet of lipoma should be thinned using an ultrasonic surgical aspirator; alternatively, a carbon-dioxide laser may be used to debulk the lipoma.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">7</span></a> If nerve roots are involved in the exophytic part of the lesion, they should be left intact during the surgery.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">9</span></a> Intraoperative neurophysiological monitoring is essential to reduce the risk of high morbidity.<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">7,9</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conclusion</span><p id="par0065" class="elsevierStylePara elsevierViewall">Non-dysraphic intradural craniocervical lipomas are rare lesions that are usually reported in children because of their congenital origin. However, in extremely rare cases, they can cause slowly-progressive symptoms in adults. MRI is the most efficient diagnostic tool for such lipomas. Given the firm adherence between the lipoma and neural tissues, subtotal excision and neural decompression are often considered the best options as radical surgical excision usually causes a high rate of morbidity.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Funding</span><p id="par0070" class="elsevierStylePara elsevierViewall">The financing of the article has been met by the authors.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conflict of interest</span><p id="par0075" class="elsevierStylePara elsevierViewall">There is no conflict of interest between the authors.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres1239290" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1150159" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1239291" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1150160" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Case report" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Conclusion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Funding" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflict of interest" ] 10 => array:2 [ "identificador" => "xack424248" "titulo" => "Acknowledgment" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-06-06" "fechaAceptado" => "2018-09-30" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1150159" "palabras" => array:4 [ 0 => "Non-dysraphism" 1 => "Intramedullary" 2 => "Lipoma" 3 => "Craniocervical region" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1150160" "palabras" => array:4 [ 0 => "No-disrafismo" 1 => "Intramedular" 2 => "Lipoma" 3 => "Región craneocervical" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Intradural spinal lipomas with intracranial extension are very rare and are typically diagnosed in childhood. Radical surgical excision usually causes a high rate of morbidity because of the firm adherence between the lipoma and neural tissues. In this report, we present a case of craniocervical intradural intramedullary lipoma in an adult patient. The patient underwent surgery with excision of the mass, leaving a sheet of lipoma on the tumor bed.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Los lipomas espinales intradurales con extensión intracraneal son muy raros y suelen diagnosticarse en la infancia. La escisión quirúrgica radical generalmente causa una alta tasa de morbilidad debido a la adherencia firme entre el lipoma y los tejidos neurales. En este artículo, presentamos un caso de lipoma intramedular craneocervical intradural en un paciente adulto. El paciente se sometió a una cirugía con exéresis de la masa, dejando una lámina de lipoma en el lecho tumoral.</p></span>" ] ] "multimedia" => array:6 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2040 "Ancho" => 1200 "Tamanyo" => 226438 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Sagittal computed tomography image of the craniocervical region showing hypodense intraspinal mass with intracranial extension.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2280 "Ancho" => 1267 "Tamanyo" => 210510 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Sagittal T1-weighted non-contrast magnetic resonance image of the craniocervical region showing hyperintense mass, suggesting intraspinal lipoma with posterior fossa extension.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 944 "Ancho" => 1267 "Tamanyo" => 262682 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Intraoperative view of the lipoma after durotomy.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Fig. 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 950 "Ancho" => 1267 "Tamanyo" => 145220 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">The excised lipoma.</p>" ] ] 4 => array:7 [ "identificador" => "fig0025" "etiqueta" => "Fig. 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 1452 "Ancho" => 1267 "Tamanyo" => 159827 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">T1-weighted MR image obtained 8 years after the surgery, showing residual mass.</p>" ] ] 5 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Author/year \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Age/sex \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Symptoms/duration \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Radiology \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Surgery \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Outcome \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Bertoloni GC (1985) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">62/F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Paraparesia, drop attacks/3 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CT myelography \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mc Gillicuddy GT (1987) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24/M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Right hemiparesia/a few months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CT myelography \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">70% removed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Good \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mohindra S (2009) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20/M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Spastic quadriparesia/6 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">MRI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Near-total excision \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Good \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Meher SK (2017) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30/M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Left upper monoparesia/2 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">MRI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Subtotal excision \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Good \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Present Case (2018) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">28/M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Paresia in upper extremities/3 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">MRI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Near-total excision \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Good \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2117595.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Adult cases with craniocervical intradural lipoma.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:18 [ 0 => array:3 [ "identificador" => "bib0095" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Non dysraphic intramedullary spinal cord lipomas: a review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "H.S. Bhatoe" 1 => "P. Singh" 2 => "A. Chaturvedi" 3 => "K. Sahai" 4 => "V. Putta" 5 => "P.K. Sahoo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Neurorusg Foc" "fecha" => "2005" "volumen" => "18" "paginaInicial" => "1" "paginaFinal" => "5" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0100" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "İntradural spinal lipomas not associated with spinal dysraphism: a report of four cases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "F. Fujiwara" 1 => "N. Tamaki" 2 => "T. Nagashima" 3 => "M. 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Samii" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Acta Neurochr (Wien)" "fecha" => "2001" "volumen" => "143" "paginaInicial" => "767" "paginaFinal" => "774" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0110" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cervical intramedullary lipoma with intracranial extension in an infant" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "C. Chaskis" 1 => "A. Michotte" 2 => "F. Gefray" 3 => "J. Vangeneugden" 4 => "B. Desprechins" 5 => "J. 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Goel" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jocn.2006.07.018" "Revista" => array:6 [ "tituloSerie" => "J Clin Neurosci" "fecha" => "2008" "volumen" => "15" "paginaInicial" => "817" "paginaFinal" => "820" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18439829" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0120" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "An infant with an intradural lipoma of the cervical spine extending into the posterior fossa" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "Y. Kai" 1 => "T. Amano" 2 => "T. Inamura" 3 => "T. Matsushima" 4 => "M. Takamatsu" 5 => "E. Kai" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Clin Neurosci" "fecha" => "2003" "volumen" => "10" "paginaInicial" => "127" "paginaFinal" => "130" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12464545" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0125" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Nondysraphic cervicomedullary intramedullary lipoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S.K. Meher" 1 => "L.N. Tripathy" 2 => "H. Jain" 3 => "S. 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