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Yoshinori Ishikawa, Yoichi Shimada, Naohisa Miyakoshi, Tetsuya Suzuki, Michio Hongo, Yuji Kasukawa, Kyoji Okada and Eiji Itoi

Object

Idiopathic symptomatic spinal epidural lipomatosis (SEL) is a rare condition, and few reports have discussed diagnostic imaging criteria. To evaluate factors relating to its clinical symptoms, correlations between clinical features and the presence of spinal epidural fat were investigated, and the literature concerning idiopathic SEL was reviewed.

Methods

Morphological gradings of epidural fat were evaluated in seven patients with idiopathic SEL by using magnetic resonance (MR) imaging. In addition, body mass index (BMI), the number of involved vertebral levels, grade, and preoperative Japanese Orthopaedic Association (JOA) score were analyzed. Surgery resulted in symptomatic relief, with a mean JOA score recovery rate of 67.4%. Grading of epidural fat tended to display a slight negative correlation with preoperative JOA score, whereas a strong significant positive correlation was found between the number of involved vertebral levels and BMI.

Conclusions

The number of involved vertebral levels and obesity are strongly correlated, whereas severity of dural compression is not always significantly associated with neurological complications. These results indicate that epidural fat of the lumbar spine contributes to neurological deficits. In addition, weight-reduction therapy appears to decrease the number of vertebral levels involved. Magnetic resonance imaging–based grading is helpful for the diagnosis and evaluation of idiopathic lumbar SEL. Moreover, symptoms and neurological findings are important for determining the surgical approach.

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histopathological findings in routine intervertebral disc surgery Martin Hasselblatt David Maintz Thomas Goll Uwe Wildförster Christoph Schul Werner Paulus 1 2006 4 1 20 23 10.3171/spi.2006.4.1.20 SPI.2006.4.1.20 Decompression of idiopathic lumbar epidural lipomatosis: diagnostic magnetic resonance imaging evaluation and review of the literature Yoshinori Ishikawa Yoichi Shimada Naohisa Miyakoshi Tetsuya Suzuki Michio Hongo Yuji Kasukawa Kyoji Okada Eiji Itoi 1 2006 4 1 24 30 10.3171/spi.2006.4.1.24 SPI.2006.4.1.24 Prospective randomized controlled study of the Bryan

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Daniel G. Borré

T o the E ditor : I read with great interest the article by Ishikawa et al. “Decompression of idiopathic lumbar epidural lipomatosis: diagnostic magnetic resonance imaging evaluation and review of the literature” ( J Neurosurg Spine 4: 24–30, January, 2006). I believe that the subject addressed by the authors is very important, but there are some points concerning the study that probably deserve a more thorough analysis. In the introduction the authors state that “To date only 48 cases of symptomatic idiopathic SEL for the whole spine and only 33 cases

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Dimitris Zevgaridis, Kimon Nanassis and Thomas Zaramboukas

Am J Neuroradiol 24 : 1276 – 1282 , 2003 6 Haid RW Jr , Kaufmann HH , Schochet SS , Marano GD : Epidural lipomatosis simulating an epidural abscess: case report and literature review . Neurosurgery 21 : 744 – 747 , 1987 7 Iplikcioglu AC , Berkman MZ , Sengöz A : Idiopathic spinal epi dural lipomatosis . Acta Neurochir (Wien) 140 : 405 – 406 , 1998 8 Ishikawa Y , Shimada Y , Miyakoshi N , Suzuki T , Hongo M , Kasukawa Y , : Decompression of idiopathic lumbar epidural lipomatosis: diagnostic magnetic

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Homajoun Maslehaty, Athanassios K. Petridis, Harald Barth and Hubertus Maximilian Mehdorn

Object

The aim of this study was to evaluate the diagnostic value of MR imaging in perimesencephalic (PM) and nonperimesencephalic (non-PM) subarachnoid hemorrhage (SAH) of unknown origin.

Methods

The authors conducted a retrospective review of all patients with SAH (1226 patients) in their department between January 1991 and December 2008. Included in the study were cases of spontaneous SAH diagnosed using CT scans obtained within 24 hours of the initial symptoms and initially negative digital subtraction (DS) angiograms. Patients with traumatic SAH and an unknown history were excluded from the study. Patients with initially negative DS angiograms were divided into 2 groups: Group 1, a typically PM bleeding pattern (PM SAH); and Group 2, a non-PM bleeding pattern (non-PM SAH) such as hemorrhage in the sylvian or interhemispheric fissure. Cranial MR imaging including the craniocervical region was performed within 72 hours after SAH was diagnosed in all patients in Groups 1 and 2.

Results

One thousand sixty-eight patients underwent DS angiography, and among them were 179 (16.7%) with negative angiograms—47 patients (26.3%) from Group 1 and 132 patients (73.7%) from Group 2. Magnetic resonance imaging demonstrated no bleeding sources in any case (100% negative). Thirty-four patients in Group 1 and 120 patients in Group 2 underwent a second DS angiography study. Digital subtraction angiography revealed an aneurysm as the bleeding source in 1 case in Group 1 and in 13 cases in Group 2.

Conclusions

Magnetic resonance imaging of the brain and craniocervical region did not produce additional benefit for the detection of a bleeding source and the therapy administered for PM SAH and non-PM SAH (100% negative). The costs of this examination exceeded the clinical value. Despite the results of this study, MR imaging should be discussed on a case-by-case basis because rare bleeding sources are periodically diagnosed in cases of non-PM SAH. A second-look DS angiogram is necessary because aneurysmal hemorrhage occasionally produces PM SAH as well as non-PM SAH. Further prospective studies are needed to verify the authors' results in the future.

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Daniel B. Loriaux, Owoicho Adogwa and Oren N. Gottfried

and literature review . Neurosurgery 21 : 744 – 747 , 1987 4 Hungs M , Paré LS : Spinal angiolipoma: case report and literature review . J Spinal Cord Med 31 : 315 – 318 , 2008 5 Ishikawa Y , Shimada Y , Miyakoshi N , Suzuki T , Hongo M , Kasukawa Y , : Decompression of idiopathic lumbar epidural lipomatosis: diagnostic magnetic resonance imaging evaluation and review of the literature . J Neurosurg Spine 4 : 24 – 30 , 2006 6 Kim HK , Koh SH , Chung KJ : Solitary epidural lipoma with ipsilateral facet arthritis