Lipomyelomeningocele: A Case Report

Introduction: Lipomyelomeningocele (LMMC) is a neural tube defect with neural elements incorporated into the spinal lipoma with the prevalence ranging from 0.3-0.6 per 10000 live births. Lipomyelomeningocele is a form of closed spinal dysraphism presenting as a subcutaneous fatty mass over the inter-gluteal cleft. It is a lipoma fused to a dorsally split spinal cord. It can present with cutaneous manifestations, musculoskeletal features, urological features and neurological features. Case: Our patient is a 2 year old girl with no history of complications at birth who was referred to the neurosurgery outpatient department with complaints of swelling in the lower back and a cutaneous dimple since birth. An initial ultrasound at birth had showed features of spinal dysraphism. The patient was asymptomatic with normal strength of the lower extremities. The preoperative study included MRI of the lumbosacral spine with T1 weighted image (plain and contrast) and screening of the brain and was correlated with CT scan at the level of L2 to L5. It showed closed spinal dysraphism with lipomyelomeningocele from L2 to L5 level with tethered spinal cord, herniated tissue measures 11.5 x 4.4 x 7 cm, sacral agenesis with an open defect of 3cm with ossified bony component in the subcutaneous plane at L2-L5 level measuring 5 x 3 cm on the left side. The patient underwent repair of the lipomyelomeningocele under general anesthesia. Conclusion: The management of lipomyelomeningocele is challenging with surgical management being done in patients with progressive symptoms. The clinical management of the lesion depends on the severity. Asymptomatic patients can be treated conservatively with regular follow up. Surgical intervention is planned in symptomatic patients such as sensorimotor deficits, progressive worsening of musculoskeletal abnormalities. Early surgery in asymptomatic patients can prevent the development of neurological deficits.