Non-dysraphic intramedullary lipoma: a case report and review of literature

Abstract Background Non-dysraphic intramedullary lipomas (NDIL) are rare spinal cord tumors that lack spinal dysraphism features, presenting diagnostic and therapeutic challenges. We report a case of a 2-month-old male with a cervicothoracic intramedullary lipoma. Case presentation He presented with rapid-onset of upper limb plegia. MRI revealed an intramedullary cervicothoracic lesion with hyperintensity on both T1 and T2-weighted images and fat suppression on STIR sequences, compatible with an intramedullary lipoma. Due to the rapid progression of neurological deficits, surgical decompression was performed. Intraoperative neurophysiological monitoring was used to optimize neurological safety. A subtotal resection of the lipoma was performed with preservation of neurological function. Postoperative MRI confirmed a reduction in lesion size, and early motor recovery was noted, allowing the child to achieve functional mobility by the time of discharge. At the 2-year follow-up, the patient exhibited near-complete recovery, with only mild residual paresis. Conclusion NDIL, though rare, can lead to significant neurological compromise. Early surgical intervention with subtotal resection and neuromonitoring is effective for decompression while minimizing neurological risks. Long-term follow-up is essential to monitor for recurrence or growth. This case underscores the importance of timely diagnosis and management to prevent irreversible neurological deficits in patients with NDIL.