Objective and importance: Holocord intradural lipoma extending from the cervical to the lumbar spine is an exceedingly rare condition. An extensive review of the literature revealed that only eight other cases have been reported, and none occurred during the contemporary magnetic resonance imaging era.
Clinical presentation: A case of holocord intradural lipoma that was partially resected with the aid of carbon dioxide laser and intraoperative ultrasound is reported.
Technique: The intimate relationship of the lipoma to the nerve roots and the absence of a distinct plane between tumor and spinal cord precluded a complete resection of this tumor. At 7 months postoperatively, the patient's dysesthetic pain had resolved almost completely. Proprioception in the lower extremities had improved significantly to the point that the patient was able to walk without a cane and his preoperative Romberg's sign had disappeared.
Conclusion: Extensive intradural intramedullary spinal lipomas can present in adulthood with symptoms of myelopathy as well as nonradicular pain. We encourage early surgical debulking of the tumor to prevent further progression of symptoms and to offer the possibility of neurological improvement.