Radiologic diagnosis of intramedullary lipomas has been unreliable for a long time and many of these tumors have not been recognized. The introduction of computed tomography, and lately of magnetic resonance imaging, has led to great progress in the accurate identification of spinal cord tumors as well as in the recognition of type specificity of these lesions. An evaluation of the diagnostic value of magnetic resonance imaging and microsurgical technique for the optimal therapeutic outcome is discussed.