Endoscopic suction decompression of idiopathic epidural lipomatosis.
BACKGROUND
Epidural lipomatosis can be idiopathic or associated with obesity and steroid excess. This disorder can be treated by weight control, reduction of steroid load, or operative decompression. We describe a non-obese patient with neurogenic claudication who had localized epidural fat from L4 to S1. Minimally invasive treatment consisted of a small laminotomy and endoscopically guided fat aspiration.


METHODS
A small bilateral L5-S1 laminotomy was performed. Using a special malleable endoscopic aspirator, loose fat was removed both dorsal and ventral to the dural sac.


RESULTS
At surgery, endoscopically guided suction aspiration was successful in removing the majority of the fat. Areas of fat that were vascularized and adherent to the dura required microsurgical dissection. Postoperatively, the patient has been asymptomatic.


CONCLUSIONS
This minimally invasive technique was successful in treating epidural dual compression that had failed conservative measures. Further evaluation of this technology is warranted.
Frank
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Department of Neurosurgery, Oregon Health Sciences University, Portland 97201, USA.
D000273:Adipose Tissue / Q000601:surgery; D004724:Endoscopy / Q000379:methods*; D004824:Epidural Space / Q000601:surgery; D006801:Humans; D008068:Lipomatosis / Q000150:complications* / Q000473:pathology / Q000601:surgery*; D008161:Lumbosacral Region; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D013117:Spinal Cord Compression / Q000209:etiology* / Q000473:pathology / Q000601:surgery*; D013396:Suction / Q000379:methods