Neurology India Medknow Publications on behalf of the Neurological Society of India ISSN: 0028-3886 EISSN: 1998-4022 Vol. 59, Num. 4, 2011, pp. 654-654

Neurology India, Vol. 59, No. 4, July-August, 2011, pp. 654

Correspondence

Thoracic epidural angiolipoma with extraspinal extension

Mehmet Turgut

Department of Neurosurgery, Adnan Menderes University School of Medicine, Aydin, Turkey
Correspondence Address: Mehmet Turgut, Department of Neurosurgery, Adnan Menderes University School of Medicine, Aydin, Turkey, drmturgut@yahoo.com

Date of Submission: 10-Jun-2011
Date of Decision: 11-Jun-2011
Date of Acceptance: 21-Jun-2011

Code Number: ni11203

PMID: 21891966

DOI: 10.4103/0028-3886.84370

Sir,

Angiolipomas of the spinal canal are extremely uncommon benign tumors, may be infiltrating or non-infiltrating and are composed of mature lipomatous and angiomatous elements. ^[1] Clinical presentation is nonspecific and magnetic resonance imaging (MRI) is the imaging modality of choice. I read with interest the article entitled "Thoracic epidural angiolipoma with bilateral multilevel extraspinal extensions: A rare entity" by Diyora et al. ^[2] published in this journal and wish to congratulate my colleagues on this unique contribution to the literature on spinal angiolipoma. Nevertheless, I wish to add some important points to the discussion. I recently reviewed the world literature and found a total of 142 cases with spinal extradural angiolipoma to date, including the new case reported by Diyora et al. ^[2] From a surgical standpoint, it is important to know that "dumbbell" spinal angiolipomas with extraspinal extensions are treated by a combined microneurosurgical and thoracoscopic approach, requiring a multidisciplinary approach. ^[3],[4],[5] There is an inconsistency regarding the MRI findings of spinal angiolipoma on T1- and T2-weighted sequences within the text. As a rule, these neoplasms show iso- or hyperintensity on T1-weighted images and hyperintensity on T2-weighted images, enhancing with gadolinium administration. Finally, it seems that there is a potential error concerning the dermatomal level of sensory loss on neurological examination because of the well-known anatomic relationship between cord segments and the vertebral bodies and spines in adults due to the different growth rates of the cord and spine. Undoubtedly, it is of clinical importance both in determination of the correct level of a spinal cord lesion and in selection of the appropriate surgical approach.

References

1.	Turgut M. Spinal angiolipomas: report of a case and review of the cases published since the discovery of the tumour in 1890. Br J Neurosurg 1999;13:30-40.  Back to cited text no. 1
2.	Diyora B, Nayak N, Kukreja S, Kamble H, Sharma A. Thoracic epidural angiolipoma with bilateral multilevel extraspinal extensions: A rare entity. Neurol India 2011;59:134-6.  Back to cited text no. 2  [PUBMED]
3.	Choi JY, Goo JM, Chung MJ, Kim HC, Im JG. Angiolipoma of the posterior mediastinum with extension into the spinal canal: a case report. Korean J Radiol 2000;1:212-4.  Back to cited text no. 3
4.	Negri G, Puglisi A, Gerevini S, Voci C, Zannini P. Thoracoscopic techniques in the management of benign mediastinal dumbbell tumors. Surg Endosc 2001;15:897.  Back to cited text no. 4
5.	Gámez García P, de Pablo Gafas A, Salas Antón C, Santolaya Cohen R, Madrigal Royo L, Varela de Ugarte A. Mediastinal dumbbell angiolipoma. Arch Bronconeumol 2002;38:545-6.  Back to cited text no. 5

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