Objective   To explore the clinical characteristics and the microneurosurgical treatment for spinal intramedullary lipoma under the monitoring of intraoperative evoked potentials.    Methods   The clinical data of 4 patients with spinal intramedullary lipoma from March 2003 to January 2009 hospitalized in the First Affiliated Hospital of Chongqing Medical University were collected and analyzed retrospectively. The clinical presentation

diagnostic method

treatment and outcome were evaluated.    Results   Under intraoperative evoked potentials monitoring

all 4 patients were treated microneurosurgically with tumor subtotal or partial resection operation

lumbar decompressive laminectomy and duraplasty to relieve tension. Three out of them were improved in nervous system function.    Conclusion   MRI scan is by far the best option to diagnose spinal intramedullary lipoma. Intraoperative evoked potentials can help to enhane the accuracy of microsurgery for spinal intramedullary lipoma and decrease surgical complications.