Non-dysraphic cervicothoracic intramedullary lipoma: A case report and literature review

Introduction Intramedullary spinal cord lipomas are rare, comprising less than 1% of all intramedullary spinal tumors. Most are associated with spinal dysraphism, especially in the lumbosacral region. Non-dysraphic intramedullary lipomas, particularly in the cervicothoracic spine, are exceptionally rare. Case presentation We present a 36-year-old female with a recurrent intramedullary lipoma at the C6–T2 level, initially resected in 2019. She developed progressive weakness, numbness, gait instability, and sphincter dysfunction over two years. MRI revealed a recurrent, intradural fat-signal lesion compressing the spinal cord. She underwent subtotal resection with tumor debulking using the Cavitron Ultrasonic Surgical Aspirator (CUSA). Postoperatively, she showed partial neurological improvement but developed bilateral lower limb paraplegia. She was referred to a specialized rehabilitation center. Discussion Non-dysraphic intramedullary lipomas present diagnostic and therapeutic challenges due to their rarity and intimate involvement with spinal cord tissue. MRI is the diagnostic modality of choice. Surgery is typically reserved for symptomatic cases, with subtotal resection favored to minimize neurological risk. Despite intervention, recurrence and further decline remain concerns. Conclusion Non-dysraphic cervicothoracic intramedullary lipomas require individualized surgical strategies and long-term rehabilitation. This case highlights the complexity of managing these rare lesions and underscores the importance of balancing decompression with neurological preservation.