Download PDF
J Neurol Surg A Cent Eur Neurosurg 2022; 83(02): 161-172
DOI: 10.1055/s-0041-1739217
Review Article

Thoracic Spinal Angiolipomas: A Systematic Review

Giuseppe Emmanuele Umana 
1   Department of Neurosurgery, Cannizzaro Hospital, Catania, Italy
,
Massimiliano Visocchi
2   Department of Neurosurgery, Policlinico Universitario Agostino Gemelli, Roma, Lazio, Italy
3   Catholic University of the Sacred Heart Rome Campus, Roma, Italy
,
Elena Roca
4   Department of Neurosurgery, Head and Neck Surgery, Poliambulanza Foundation Hospitals, Brescia, Lombardia, Italy
,
Maurizio Passanisi
5   Department of Neurosurgery, Azienda Ospedaliera Cannizzaro, Catania, Sicilia, Italy
,
Marco Fricia
1   Department of Neurosurgery, Cannizzaro Hospital, Catania, Italy
,
Maria Grazia Tranchina
6   Department of Pathological Anatomy, Cannizzaro Hospital, Catania, Sicilia, Italy
,
Santino Ottavio Tomasi
7   Department of Neurosurgery, Paracelsus Medical Private University, Salzburg, Austria
,
Giovanni Federico Nicoletti
8   Department of Neurosurgery, National Specialist Hospital Garibaldi, Catania, Sicilia, Italy
,
Salvatore Cicero
1   Department of Neurosurgery, Cannizzaro Hospital, Catania, Italy
,
Gianluca Scalia 
8   Department of Neurosurgery, National Specialist Hospital Garibaldi, Catania, Sicilia, Italy
› Author Affiliations Funding None.
› Further Information
    Permissions and Reprints

Abstract

Background Spinal angiolipomas (SAs) are rare, benign tumors, representing 0.0004 to 1.2% of angiolipomas, usually located at the extradural and posterior thoracic level, with multimetameric extension.

Methods A systematic literature review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The authors searched on PubMed and Scopus databases for published articles with the Mesh term “spinal angiolipoma” and pertinent associations. Language restriction to English papers was applied. The authors also reported three emblematic cases of patients who underwent surgical resection of spindle-shaped (type IA) and dumbbell-shaped (type II) SAs between 2014 and 2020.

Results Of the 256 retrieved articles, 33 were included in the meta-analysis. These 33 studies, together with our 3 reported cases, included a total of 60 patients, 36 females (60%) and 24 males (40%), with a mean age of 53.12 ± 12.82 years (range: 12–77 years).

T5 was the most represented level (22 patients). Usually, the localization of SA was extradural, with 53 patients suffering from spindle-shaped type IA SA (88.3%) and 7 patients from dumbbell-shaped type II SA (11.6%). Almost all patients underwent laminectomy (78.3%) and presented a full recovery of motor deficits (85%). Gross total removal (GTR) was performed in 93.3% of patients. The mean follow-up was of 22.71 ± 21.45 months (range: 2–80 months). There was no documented recurrence at follow-up magnetic resonance imaging in any of the patients.

Conclusions SAs are rare, benign tumors with a great vascular component that presents a favorable outcome. GTR is the gold standard treatment and usually an adjuvant therapy is not required. Even infiltrative lesions, which are more complex, can be treated successfully with a good prognosis. Dumbbell-shaped SAs must be differentiated from schwannomas and meningiomas, and require different surgical techniques, given the profuse bleeding associated with the attempt of debulking. En block resection is the key to treat these common benign tumors with acceptable blood loss.

Keywords

Spinal angiolipomas - tumor - paravertebral - costotransversectomy - laminectomy


Publication History

Received: 31 October 2020

Accepted: 14 May 2021

Article published online:
20 December 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Garg A, Gupta V, Gaikwad S. et al. Spinal angiolipoma: report of three cases and review of MRI features. Australas Radiol 2002; 46 (01) 84-90
    CrossrefPubMedGoogle Scholar
  • 2 Kujas M, Lopes M, Lalam TF, Fohanno D, Poirier J. Infiltrating extradural spinal angiolipoma. Clin Neuropathol 1999; 18 (02) 93-98
    PubMedGoogle Scholar
  • 3 Amlashi SFA, Morandi X, Chabert E, Riffaud L, Haegelen C, Rolland Y. Spinal epidural angiolipoma. J Neuroradiol 2001; 28 (04) 253-256
    PubMedGoogle Scholar
  • 4 Fourney DR, Tong KA, Macaulay RJB, Griebel RW. Spinal angiolipoma. Can J Neurol Sci 2001; 28 (01) 82-88
    CrossrefPubMedGoogle Scholar
  • 5 Leu NH, Chen CY, Shy CG. et al. MR imaging of an infiltrating spinal epidural angiolipoma. AJNR Am J Neuroradiol 2003; 24 (05) 1008-1011
    PubMedGoogle Scholar
  • 6 Lin JJ, Lin F. Two entities in angiolipoma. A study of 459 cases of lipoma with review of literature on infiltrating angiolipoma. Cancer 1974; 34 (03) 720-727
    CrossrefPubMedGoogle Scholar
  • 7 Guzey FK, Bas NS, Ozkan N, Karabulut C, Bas SC, Turgut H. Lumbar extradural infiltrating angiolipoma: a case report and review of 17 previously reported cases with infiltrating spinal angiolipomas. Spine J 2007; 7 (06) 739-744
    CrossrefPubMedGoogle Scholar
  • 8 Shibata Y, Sugimoto K, Matsuki T, Nose T. Thoracic epidural angiolipoma: case report. Neurol Med Chir (Tokyo) 1993; 33 (05) 316-319
    CrossrefPubMedGoogle Scholar
  • 9 Preul MC, Leblanc R, Tampieri D, Robitaille Y, Pokrupa R. Spinal angiolipomas. Report of three cases. J Neurosurg 1993; 78 (02) 280-286
    CrossrefPubMedGoogle Scholar
  • 10 Bouramas D, Korres DS, Roussos L, Mantzilas T, Anagnostopoulos D. Spinal extradural angiolipoma. J Spinal Disord 1995; 8 (04) 324-327
    CrossrefPubMedGoogle Scholar
  • 11 Labram EK, el-Shunnar K, Hilton DA, Robertson NJ. Revisited: spinal angiolipoma: three additional cases. Br J Neurosurg 1999; 13 (01) 25-29
    CrossrefPubMedGoogle Scholar
  • 12 Oge HK, Söylemezoglu F, Rousan N, Ozcan OE. Spinal angiolipoma: case report and review of literature. J Spinal Disord 1999; 12 (04) 353-356
    PubMedGoogle Scholar
  • 13 al-Anazi A, Ammar A, Shannon P, al-Mulhim F. Spinal extradural angiolipoma. Br J Neurosurg 2000; 14 (05) 471-472
    CrossrefPubMedGoogle Scholar
  • 14 Rabin D, Hon BA, Pelz DM, Ang LC, Lee DH, Duggal N. Infiltrating spinal angiolipoma: a case report and review of the literature. J Spinal Disord Tech 2004; 17 (05) 456-461
    CrossrefPubMedGoogle Scholar
  • 15 Samdani AF, Garonzik IM, Jallo G, Eberhart CG, Zahos P. Spinal angiolipoma: case report and review of the literature. Acta Neurochir (Wien) 2004; 146 (03) 299-302 , discussion 302
    CrossrefPubMedGoogle Scholar
  • 16 Yen HL, Tsai SC, Liu SM. Infiltrating spinal angiolipoma. J Clin Neurosci 2008; 15 (10) 1170-1173
    CrossrefPubMedGoogle Scholar
  • 17 Hungs M, Paré LS. Spinal angiolipoma: case report and literature review. J Spinal Cord Med 2008; 31 (03) 315-318
    CrossrefPubMedGoogle Scholar
  • 18 Farooq MU, Samaraweera R, Heilman T, Chang HT. Spinal cavernous angiolipoma. Arch Neurol 2008; 65 (07) 981-982
    CrossrefPubMedGoogle Scholar
  • 19 Fujiwara H, Kaito T, Takenaka S, Makino T, Yonenobu K. Thoracic spinal epidural angiolipoma: report of two cases and review of the literature. Turk Neurosurg 2013; 23 (02) 271-277
    PubMedGoogle Scholar
  • 20 Chotai S, Hur JS, Moon HJ, Kwon TH, Park YK, Kim JH. Spinal angiolipoma: case report. Neurol Med Chir (Tokyo) 2011; 51 (07) 539-542
    CrossrefPubMedGoogle Scholar
  • 21 Ghanta RK, Koti K, Dandamudi S. Spinal epidural angiolipoma: a rare cause of spinal cord compression. J Neurosci Rural Pract 2012; 3 (03) 341-343
    Article in Thieme ConnectPubMedGoogle Scholar
  • 22 Han SR, Yee GT, Choi CY, Lee CH. Infiltrating spinal angiolipoma. J Korean Neurosurg Soc 2012; 52 (02) 161-163
    CrossrefPubMedGoogle Scholar
  • 23 Meng J, Du Y, Yang HF. et al. Thoracic epidural angiolipoma: a case report and review of the literature. World J Radiol 2013; 5 (04) 187-192
    CrossrefPubMedGoogle Scholar
  • 24 Nakao Y, Shimokawa N, Tsukazaki Y, Terada A, Nakajo K, Fu Y. Radical excision combined with instrumented fixation in the management of thoracic epidural angiolipoma: a case report. J Med Case Reports 2014; 8 (08) 377
    CrossrefPubMedGoogle Scholar
  • 25 Si Y, Wang Z, Pan Y, Lin G, Yu T. Spinal angiolipoma: etiology, imaging findings, classification, treatment, and prognosis. Eur Spine J 2014; 23 (02) 417-425
    CrossrefPubMedGoogle Scholar
  • 26 Wang B, Yang Z, Yang J, Wang G, Xu Y, Liu P. Spinal angiolipoma: experience of twelve patients and literature. Neurol India 2014; 62 (04) 367-370
    CrossrefPubMedGoogle Scholar
  • 27 Benvenutti-Regato M, De la Garza-Ramos R, Caro-Osorio E. Thoracic epidural spinal angiolipoma with coexisting lumbar spinal stenosis: case report and review of the literature. Int J Spine Surg 2015; 9 (09) 67
    CrossrefPubMedGoogle Scholar
  • 28 Nadi MM, Nadi AM, Zabara MY, Ahmad TM. Management of infiltrating spinal epidural angiolipoma. Neurosciences (Riyadh) 2015; 20 (02) 159-163
    CrossrefPubMedGoogle Scholar
  • 29 Sim K, Tsui A, Paldor I, Kaye AH, Gaillard F. Four cases of spinal epidural angiolipoma. J Clin Neurosci 2016; 25: 134-139
    CrossrefPubMedGoogle Scholar
  • 30 Mohammed Y, Elhamdani S, Farooq M, Mazagri R. A case report and review of thoracic spinal angiolipoma. Surg Neurol Int 2017; 8: 113
    CrossrefPubMedGoogle Scholar
  • 31 Onishi FJ, Salem FAS, de Melo Lins DL, Dauar RFB, Stavale JN. Spinal thoracic extradural angiolipoma manifesting as acute onset of paraparesis: Case report and review of literature. Surg Neurol Int 2017; 8: 150
    CrossrefPubMedGoogle Scholar
  • 32 Wang FF, Wang S, Xue WH, Cheng JL. Epidural spinal angiolipoma: a case series. BMC Res Notes 2017; 10 (01) 128
    CrossrefPubMedGoogle Scholar
  • 33 Rkhami M, Kedous MA, Achoura S, Zehani A, Bahri K, Zammel I. Epidural angiolipoma: a rare cause of spinal cord compression. Int J Surg Case Rep 2018; 45: 72-76
    CrossrefPubMedGoogle Scholar
  • 34 Rong HT, Fan YS, Li SP. et al. Management of dumbbell and paraspinal tumors of the thoracic spine using a single-stage posterolateral approach: case series. Orthop Surg 2018; 10 (04) 343-349
    CrossrefPubMedGoogle Scholar
  • 35 Wani AA, Sarmast AH, Ramzan AU. et al. Spinal angiolipoma mimicking a schwannoma: a case report. Surg Neurol Int 2018; 9: 79
    CrossrefPubMedGoogle Scholar
  • 36 Maduri R, Belouaer A, Brouland JP, Ecker T, Messerer M. Spinal angiolipomas in pregnancy: natural history and surgical treatment. Clin Neurol Neurosurg 2019; 178: 25-30
    CrossrefPubMedGoogle Scholar
  • 37 Wang R, Tang H. Spinal angiolipoma: a report of two cases and review of the literature. J Int Med Res 2020; 48 (09) 300060520954690
    Google Scholar
  • 38 Yang T, Niu C. Microsurgical treatment for spinal epidural angiolipomas. Acta Neurol Belg 2019
    PubMedGoogle Scholar
  • 39 Gonzalez-Crussi F, Enneking WF, Arean VM. Infiltrating angiolipoma. J Bone Joint Surg Am 1966; 48 (06) 1111-1124
    CrossrefPubMedGoogle Scholar
  • 40 Rubin G, Gornish M, Sandbank J, Shevach I, Rappaport ZH. Spinal extradural angiolipoma. Case report and review of the literature. Spine 1992; 17 (06) 719-724
    CrossrefPubMedGoogle Scholar
  • 41 Fogel GR, Cunningham III PY, Esses SI. Spinal epidural lipomatosis: case reports, literature review and meta-analysis. Spine J 2005; 5 (02) 202-211
    CrossrefPubMedGoogle Scholar
  • 42 Murphey MD, Carroll JF, Flemming DJ, Pope TL, Gannon FH, Kransdorf MJ. From the archives of the AFIP: benign musculoskeletal lipomatous lesions. Radiographics 2004; 24 (05) 1433-1466
    CrossrefPubMedGoogle Scholar
  • 43 Groen RJ. Non-operative treatment of spontaneous spinal epidural hematomas: a review of the literature and a comparison with operative cases. Acta Neurochir (Wien) 2004; 146 (02) 103-110
    CrossrefPubMedGoogle Scholar
  • 44 Miki T, Oka M, Shima M, Hirofuji E, Tanaka S. Spinal angiolipoma. A case report. Acta Neurochir (Wien) 1981; 58 (1-2): 115-119
    CrossrefPubMedGoogle Scholar
  • 45 Provenzale JM, McLendon RE. Spinal angiolipomas: MR features. AJNR Am J Neuroradiol 1996; 17 (04) 713-719
    PubMedGoogle Scholar
  • 46 Trabulo A, Cerqueira L, Monteiro J, Roque P, Reis FC, Coelho MR. Spinal angiolipomas revisited: two case reports. Acta Neurochir (Wien) 1996; 138 (11) 1311-1319
    CrossrefPubMedGoogle Scholar
  • 47 Tsutsumi S, Nonaka Y, Abe Y, Yasumoto Y, Ito M. Spinal angiolipoma in a pregnant woman presenting with acute epidural hemorrhage. J Clin Neurosci 2011; 18 (06) 849-851
    CrossrefPubMedGoogle Scholar
  • 48 Gelabert-González M, García-Allut A. Spinal extradural angiolipoma: report of two cases and review of the literature. Eur Spine J 2009; 18 (03) 324-335
    CrossrefPubMedGoogle Scholar
  • 49 Akyuva Y, Gonultas A, Karaaslan N. et al. Lumbar spinal angiolipoma with expanding left neural foramen mimicking lumbar schwannoma; case report and review of the literature. Open Neurol J 2017; 11: 20-26
    CrossrefPubMedGoogle Scholar
  • 50 Kang HI, Kim TW, Kim EJ, Park KH. Angiolipoma on the lumbar spine. Korean J Spine 2017; 14 (03) 112-114
    CrossrefPubMedGoogle Scholar
  • 51 Balado M, Morea R. Extramedular haemangioma producing paraplegia during pregnancy. Arch Argent Neurol 1928; 1: 345-351
    PubMedGoogle Scholar
  • 52 Guegan Y, Fardoun R, Launois B, Pecker J. Spinal cord compression by extradural fat after prolonged corticosteroid therapy. J Neurosurg 1982; 56 (02) 267-269
    CrossrefPubMedGoogle Scholar
  • 53 O'Donovan NA, Naik K, Maloney WJ, Llewellyn CG. Spinal angiolipoma mimicking extradural lipomatosis. Can Assoc Radiol J 1996; 47 (01) 51-53
    PubMedGoogle Scholar
  • 54 Turanzas FS, Domínguez J, Eyerbe P, Dhimes P. Infiltrating spinal angiolipoma. Case report. Neurocirugia (Astur) 1994; 5: 246-249
    CrossrefPubMedGoogle Scholar
  • 55 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 (01) 30-40
    CrossrefPubMedGoogle Scholar
  • 56 Dufrenot L, Pelé E, Cursolle JC, Coindre JM, Lepreux S. [Spinal epidural angiolipoma: a case report]. Ann Pathol 2010; 30 (01) 30-32
    CrossrefPubMedGoogle Scholar
  • 57 Anson JA, Cybulski GR, Reyes M. Spinal extradural angiolipoma: a report of two cases and review of the literature. Surg Neurol 1990; 34 (03) 173-178
    CrossrefPubMedGoogle Scholar