Lipomas of the Filum Terminale without Spinal Dysraphism

Lipomas of the filum terminale occur at the caudal tip of the spinal canal. These malformations are more common than lipomyelomeningoceles and greater than 90% are recognizable on CT or MRI.23 The finding of a thickened filum terminale and a caudally descended conus medullaris are sufficient for the diagnosis.23

Patients with lipomas of the filum terminale may have similar symptoms to patients with lipomyelomeningocele and other tethered cord syndromes, including motor weakness, sensory disturbances, bladder and bowel malfunction, and pain. Their imaging and histologic characteristics are as described for other lipomatous tumors.

Surgical resection and untethering of the spinal cord are the mainstays of treatment for symptomatic lipomas of the filum terminale. Outcome data for these patients are similar to patients with spinal cord lipomas, with the majority showing improved motor, bowel, and bladder function and decreased pain.3 Recurrence of these lipomas has not been reported. However, recurrent tethering of the spinal cord may occur and should be suspected when recurrent or progressive symptoms are noted.

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