Lipomyelomeningoceles are one of the forms of closed spinal dysraphism. They usually present as a subcutaneous fatty mass just above the intergluteal cleft. However, some lipomyelomeningoceles may occur at other locations along the spinal canal.
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Clinical presentation
Lipomyelomeningoceles may be clinically detectable as a subcutaneous fatty mass above the intergluteal crease.
Pathology
These lesions are formed mainly due to a defect in primary neurulation in which mesenchymal tissue enters into the neural placode and forms lipomatous tissue.
Radiographic features
Plain radiograph
It shows a non-specific splaying / non-fusion of the posterior elements of the spine, which usually cannot be differentiated from other spinal dysraphisms.
Ultrasound
Ultrasound will show a vertebral arch defect associated with an elongated spinal cord with the placode attached to an intrathecal echogenic fatty mass that protrudes in the dorsal subcutaneous tissue.
CT
focal enlargement of the spinal canal at the placode level
hypodense fat-attenuated mass in continuity with the subcutaneous fat planes
MRI
typically seen as a spinal defect with lipomatous tissue, covered with skin
neural placode-lipoma interface lies outside the spinal canal due to enlargement of subarachnoid space
a low-lying cord is usually present
Differential diagnosis
lipomyelocele: placode-lipoma interface lies within the spinal canal
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