Spinal angiolipoma: a systematic review and an illustrative case report of recurrent long-segment angiolipoma with mediastinal extension.

purposeSpinal angiolipomas (SALs) are rare benign tumors composed of mature adipose tissue mixed with abnormal vascular structures. Because of their rarity, their natural history, recurrence patterns, and optimal treatment strategies remain incompletely characterized. We performed a systematic review of the literature on spinal angiolipomas and presented an illustrative case of recurrent long-segment cervicothoracic SAL with mediastinal extension.

methodsA systematic literature review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Google Scholar, Europe PMC, and Scopus were searched for English-language reports of histologically confirmed spinal angiolipoma published between 1966 and December 2024. Reference lists of relevant articles were also screened. Patient-level demographic, clinical, radiological, surgical, pathological, and outcome data were extracted and analyzed descriptively, with exploratory comparative analyses where appropriate.

resultsOf 185 records screened, 125 studies met the inclusion criteria, yielding 240 patients in total, including the present illustrative case. The cohort comprised 135 females (56.3%) and 105 males (43.7%), with a mean age of 46.9 years (range, 1-81 years). The most frequently involved region was the thoracic spine (175/240, 72.9%). Non-infiltrative tumors accounted for 196/240 cases (81.7%), whereas long-segment involvement and hemorrhagic presentation were each reported in 15 cases (6.3%). Motor weakness (133/240, 55.4%) and pain (103/240, 42.9%) were the most common presenting symptoms. Gross total resection was achieved in most reported cases, and overall neurological outcomes were generally favorable. Reported recurrence was rare; however, heterogeneous and sometimes limited follow-up likely underestimates the true recurrence risk. To our knowledge, the present case is the first reported recurrent long-segment cervicothoracic spinal angiolipoma with mediastinal extension.

conclusionsSpinal angiolipomas should be considered in the differential diagnosis of epidural spinal lesions and progressive spinal cord compression. Although these tumors are generally benign and associated with favorable postoperative outcomes, infiltrative morphology may reduce the likelihood of gross total resection, and recurrence may occur in rare cases. Surgical management should prioritize safe neural decompression, and long-term clinical and radiological surveillance should be considered, particularly in infiltrative or subtotally resected lesions.