Spinal epidural angiolipomas: Clinical characteristics, management and outcomes

Abstract

Purpose: The spinal epidural angiolipomas are rare expansive processes made of mature lipomatous and angiomatous elements. They often have a benign character. Their etiology, pathogenesis remains uncertain, and it is a cause of spinal cord compression. The magnetic resonance imaging is the most important neuroradiological examination. Histological examination is the only examination to confirm the diagnosis. Surgery is the treatment of choice.

Methods: A retrospective study of all patients operated on for a spinal epidural angiolipoma at the Department of Neurosurgery at the National Institute of Neurology of Tunis between January 2000 and December 2014 (15 years) was performed. The aim of this study is to describe the clinical, radiological, histological characteristics and the treatment of this tumor.

Results: A total of nine patients were operated from January 01, 2000 to November 30, 2014. The average age of our patients was 51 years with ages that ranged from 29 to 65 with a male predominance. The period between onset of symptoms and diagnosis ranged from 24 months with an average 12 months. Posterior localization of the tumor was seen in all patients. Surgical resection was performed for all cases. The postoperative course has been satisfactory, with a complete recovery of neurological functions in all patients.

Conclusions: The spinal epidural angiolipomas is rare expansive process causing spinal cord compression. Treatment is exclusively surgical resection. The functional outcome of spinal epidural angiolipomas is particularly favorable with a complete neurological recovery is if the patient was quickly operated.

Keywords: Angiolipoma; epidural tumor; magnetic resonance imaging; pathology; spinal.

Figure 1

Lumbar magnetic resonance imaging of 61-year-old woman, sagittal T1-weighted fast-spin echo (a), sagittal T1-weighted fast-spin echo, fat-saturated images after contrast (b), T2-weighted fast spin-echo (c), and axial T2-weighted (d), showed a L1–L2 posterior epidural lesion with both lipomatous and vascular components and homogeneous contrast enhancement

Figure 2

Spinal magnetic resonance imaging in a 65-year-old woman. (A) sagittal T1-weighted (e), sagittal T2-weighted (f), axial (g), and sagittal (h) T1-weighted, showing posterior spinal epidural mass with inhomogeneous high signal on all sequences, extending from T3 to T4 and causing thecal sac compression. (B) The postoperative spinal magnetic resonance imaging in the same patient, sagittal (i) T1-weighted, sagittal (j) and axial (l) T2-weighted, axial (k) T1-weighted after contrast, showing the disappearance of the lesion

Figure 3

(a and b) The cut surface of the tumor (the same patient) is yellowish, in places hemorrhagic, firm, and spongy. (c) Histopathology examination of the tumor. Showing admixture of mature adipose tissue and vascular elements (H and E, ×40)