Intracranial lipoma. Diagnostic and therapeutic considerations

Trigeminal neuralgia caused by a cerebellopontine-angle lipoma: case report

This report describes the surgical management of a rare trigeminal neuralgia caused by a cerebellopontine (CP)-angle lipoma. A 13-year-old girl presented with typical trigeminal neuralgia in the right mandibular area. Magnetic resonance imaging (MRI) disclosed a lipoma in the right CP angle. A suboccipital craniectomy revealed a lipoma around the 7th and 8th cranial nerves, but there was no apparent lipoma on the surface of the trigeminal nerve. Since the trigeminal nerve swelled only by infiltration of the lipoma, a partial rhizotomy of the involved sensory root was inevitable. The surgery relieved her neuralgia. She remained analgesic in the mandibular area.

Lipoma of corpus callosum associated with dysraphic lesions and trisomy 13

We report on a further case of corpus callosal lipoma and frontal cranial defects. Most cases in the literature of corpus callosal lipoma in association with "dysraphic" lesions have been frontal in location. Malformation of the corpus callosum is said to be associated with 50% of these lipomas. Trisomy 13 was confirmed by the 13q14 cosmid probe on paraffin-embedded liver tissue.

Hemifacial spasm resulting from cerebellopontine angle lipoma: case report

A case of hemifacial spasm associated with a cerebellopontine angle lipoma is described. Both the seventh and the eighth cranial nerves were incorporated and distorted within this tumor, which seemed to be the cause of hemifacial spasm and other cranial nerve dysfunctions, but obvious vascular elements were not included. To identify a cerebellopontine angle lesion as a lipoma is very important in surgical management. Magnetic resonance imaging is essential to the differential diagnosis of the cerebellopontine angle lesion.

Congenital triventricular hydrocephalus associated with a small lipoma in the quadrigeminal plate cistern

A case of neonatal congenital triventricular hydrocephalus due to a small intracranial lipoma in the quadrigeminal plate cistern is reported. The patient was treated by a ventriculoperitoneal shunt. The mechanism of obstructive hydrocephalus caused by the intracranial lipoma is discussed.

Computed tomography of an intracranial lipoma confined in the suprasellar cistern

A case of large intracranial lipoma involving the suprasellar cistern is presented in a 50-yr-old man with a history of occipital headaches. Evaluations by routine computed tomography (CT) combined with metrizamide CT cisternography were extremely useful in the diagnosis of this rare condition. Intracranial lipomas are reviewed in the literature and the role of CT evaluations is discussed.

Lipoma of the cerebellopontine angle. Case reports and literature review

Two patients with cerebellopontine angle (CPA) lipoma were studied. They were submitted to surgical treatment. Available literature was reviewed and 29 cases with same lesion were identified which had been treated by surgery. Clinical manifestations, possibility of diagnostic methods, surgical indications and treatment strategies are discussed. Attention is called to the peculiarities of CPA lipomas and the doubtful validity of attempting complete excision in all cases.

Intracranial lipoma of the Sylvian region

The incidental autopsy finding of an intracranial lipoma in the left Sylvian region is reported. This is a rare location for an uncommon lesion. A recent theory on its pathogenesis as a congenital lesion is presented and current methods of diagnosis and treatment are discussed.

Lipoma on surface of centroparietal lobes

A 4-year-old Japanese boy with an intracranial lipoma above the surface of the left centroparietal lobes is reported. Paresthesia occurred in the right lower extremity. This symptom continued for 30 min and recurred several times a day. Three weeks after onset, the paresthesia disappeared spontaneously. Ten months after onset, generalized tonic seizures occurred. Routine cranial computed tomography at onset revealed no remarkable lesion, but subsequently full scans, including the slice at the top of the cerebrum, revealed low-density areas on the surface of the left centroparietal lobes. T1-weighted magnetic resonance imaging revealed a hyperintense area in the same regions. The intensity of these areas was decreased by the fat saturation technique; therefore, an intracranial lipoma at a very rare site was diagnosed.

Lipoma of the cerebral cortex: case report

The first clinically diagnosed and successfully operated case of a symptomatic lipoma involving the cerebral cortex is reported. The patient presented with severe headaches and recurring focal seizures with secondary generalization. Computer tomography scan and magnetic resonance imaging suggested a left frontoparietal lipoma. After undergoing a craniotomy and tumor excision, the patient has shown resolution of headaches and seizures at 1-year follow-up. Lipomas of the cerebral cortex should be excised if symptomatic and accessible.

MRI of dorsal mesencephalic lipomas

We detected 23 intracranial lipomas using MRI. Among them were nine pericallosal lipomas, six lipomas at the dorsal surface of the midbrain, and eight in other locations. In this paper, six lipomas at the dorsal surface of the midbrain were analyzed. Five of these lipomas were in the quadrigeminal cistern and one in the left-sided quadrigeminal cistern. Excluding the smallest lipoma, five of the six lipomas had irregular margins and were broadly based on the surface of the midbrain. In these five cases, deformities of the brain parenchyma were observed adjacent to the lipomas. A mildly dilated ventricular system was observed in one of the largest lipomas in a quadrigeminal cistern. Based on their characteristic shapes and locations, we termed them "dorsal mesencephalic lipomas." Thus, the two preferential sites of intracranial lipomas were pericallosal and dorsal mesencephalic.

Ossified lipoma of the interpeduncular fossa: a case report and review of the literature

The case of a 65-year-old woman with a calcified lipoma of the interpeduncular fossa presenting with a monoparesis is reported. This was excised, resulting in an improvement of her symptoms. The literature is reviewed.

Intracranial lipoma associated with cerebral saccular aneurysm. Case report

The authors present a case of lipoma in the sylvian fissure associated with a saccular aneurysm of the middle cerebral artery. The aneurysm was successfully clipped following the partial resection of the tumor. This is the first reported case of this combined pathology. The value of cerebral angiography in this disease entity and the possible etiology of the association of an aneurysm with a lipoma are discussed.

Intracranial lipomas: current perspectives in their diagnosis and treatment

Intracranial lipomas are very rare lesions, which are probably congenital. Though they can occur anywhere in the intracranial space, a high proportion of cases tend to be ++located around the midline. They are usually asymptomatic. When symptoms do occur, they are frequently the result of co-existing general clinical conditions. Lipomas used to be reported mainly as incidental findings at autopsy, but advances in neuroimaging techniques have greatly improved the likelihood of their being discovered during life. Surgical extirpation is not necessary in the majority of patients, many of whom show remarkable clinical improvement following shunt procedures for obstructive hydrocephalus (when present) as well as vigorous treatment of co-existing conditions.

Intracranial lipomas

Intracranial lipomas are very rare, probably congenital lesions. Though they can occur anywhere in the intracranial space, a good proportion of cases tend to be located around the midline. Review of the literature as well as our own three cases--which forms the basis of this article--shows that they are mostly asymptomatic. When symptoms occur, they are frequently the result of coexisting general clinical conditions. Lipomas used to be reported mainly as incidental findings at autopsy. Advances in neuro-imaging techniques have vastly improved the likelihood of their being discovered during life. At present however, significant increase in the reported incidence of these tumours is yet to be seen. Surgical extirpation of the tumour is not considered necessary in the majority of patients, many of whom show remarkable clinical improvement following shunt procedures for obstructive hydrocephalus as well as treatment of coexisting conditions such as epilepsy.

Lipoma of the corpus callosum associated with frontal and facial anomalies

Seven patients with a corpus callosum lipoma associated with a frontal cranial defect with or without a superficial lipoma or a fronto-nasal dysplasia, were encountered over a period of 12 years. This group of patients is reported as these associated lesions may provide a lead to the cause of lipomas of the corpus callosum as well as of the different lesions in the fronto-facial region. From our experience and that of others, the frontal lesion may be an extracranial lipoma, a frontal bone defect, with or without an external lipoma, a lipomeningocele connecting the extracranial lipoma through a frontal defect with the corpus callosum lipoma, a frontal encephalocele. Fronto-nasal dysplasia associated with a corpus callosum lipoma, seems to form an independent group although some of these patients may have other extracranial lesions as well. It is suggested by the authors that as the primitive mesenchyme gives rise to the meninx primitiva as well as to the fronto-facial skeleton a disturbance of the neural crest may give rise to these combined lesions. Further analysis of similar cases may indicate the timing of these events, and perhaps reveal a common causative factor.

Cerebellopontine angle lipoma in a teenager

Lipomas of the cerebellopontine angle are very rare lesions. To date, 18 patients have been reported, 17 of whom were adults. A second child is described with cerebellopontine angle lipoma.

Lipomatous meningioma--an uncommon tumor with distinct radiographic findings

A case of lipomatous (lipoblastic) meningioma is described. Atypical radiographic features of low density on computed tomography scanning and high intensity on T1-weighted magnetic resonance imaging corresponded to the presence of adipose tissue within the tumor. A review of the literature indicates few similar reported cases.

Lipoma of the midbrain. Post-mortem finding in a patient with breast cancer

Intracranial lipomas are rare, usually do not have clinical expression and are located more frequently in the corpus callosum. Other locations include the spinal cord, midbrain tectum, superior vermis, tuber cinereum, infundibulum and more rarely cerebellopontine angle, hypothalamus, superior medullary velum and insula. We report the case of a lipoma of the left inferior colliculus which was a post-mortem finding in a woman who died of breast cancer. Although there are reports of intracranial lipomas in patients with malignant tumors there is no explanation for the co-existence of the two tumors. The present tumor also includes a segment of a nerve which is not uncommon, but a less common finding was the presence of nests of Schwann cells within it, shown by immunohistochemistry.

Lipoma of the sylvian region

An exceptional case of lipoma of the sylvian region is described and the other seven reported cases are reviewed. The sylvian fissure is the most rare site of intracranial lipomas. Sylvian lipomas may be asymptomatic or present with epileptic seizures due to irritation of the cortex of the sylvian fissure. Only two previous cases have been diagnosed during life by computerized tomography and operated on; the deep location of these lipomas and their adherences to the sylvian cortex and the branches of the middle cerebral artery make radical removal impossible and dangerous.

Lipoma of the corpus callosum: diagnosis by ultrasound and magnetic resonance

A lipoma of the corpus callosum in an infant is evaluated by ultrasound and magnetic resonance. The appearances are correlated as a diffuse but continuous aspect of this midline anomaly.

Lipoma of the infundibulum. Case report

Lipomas of the infundibulum are extremely rare and may not be recognized radiologically, even on computerized tomography (CT) scanning, if the tumor is less than 20 mm in diameter. A questionable CT diagnosis in the presence of endocrinological symptoms may justify an operation by microsurgical technique on the retrochiasmatic region. In the case reported, microsurgical removal of a small infundibular lipoma was successfully accomplished.

Lipoma of the septum pellucidum: case report

Intracranial lipomas are relatively rare maldevelopmental lesions that most characteristically occur in the corpus callosum. Although their occurrence in many other locations has been described, no report can be found of lipomas occurring in the septum pellucidum. A case is presented to document the occurrence of a lipoma of the septum pellucidum and to describe the magnetic resonance image appearance of an intracranial lipoma.

Computed tomography of lipoma of corpus callosum and choroid plexus lipoma: report of two cases

Lipoma of corpus callosum and choroid plexus lipoma are rare developmental anomalies arising as a result of maldifferentiation of primitive meningeal tissue. Two cases are reported along with a brief review of literature. The first case presented with chronic headache, and a large lipoma of corpus callosum associated with choroid plexus lipoma was discovered. The second case had no symptoms before the discovery of corpus callosal lipoma on computed tomography, which was done for a head injury. None of the lipomas showed any calcification.

Computerized tomographic and magnetic resonance imaging of intracranial lipoma. Case report

Intracranial lipoma is an uncommon lesion that has been well described in both the neurosurgical and neuroradiological literature for many years. This lesion is usually only an incidental finding, but it may be symptomatic. The authors describe a case of symptomatic intracranial lipoma of the superior medullary velum with emphasis on the correlation between computerized tomography and magnetic resonance imaging in evaluation of the lesion.

Large intramedullary lipoma of the cervical cord and posterior fossa. Case report

A large intramedullary lipoma of the cervical cord extending into the posterior fossa is reported in a 7-year-old boy. Magnetic resonance imaging was very useful for delineation of the anatomy of the lipoma as an aid in planning the operation.

Frontoethmoidal lipomeningocele

A case of lipoma in the corpus callosum associated with frontoethmoidal lipomeningocele is presented.

Lipoma of the quadrigeminal plate cistern

Two cases of quadrigeminal plate cistern lipoma detected by CT scan, one of which produced impairment of vertical gaze, are reported. The problems of diagnosis and therapy of intracranial lipomas are briefly discussed.

Lipoma in the cerebellopontine angle

A case of lipoma in the cerebellopontine angle is reported. Intracranial lipomas are very rare, especially in the cerebellopontine angle. To our knowledge, only four cases, including our own, have been operated upon. Until now, total extirpation has not been possible. The singular appearance on computed tomography scanning of this dysembryoplasia is presented together with a bibliography of this subject.

Fronto-nasal dysplasia and lipoma of the corpus callosum

A longitudinal study was performed of eight patients with fronto-nasal dysplasia. The follow-up exceeded 15 years in some patients. The eight cases showed lipoma of the corpus callosum. The only clinical alterations observed were cosmetic ones. No neurological abnormality was found, although their intellectual level was just within normal limits, the average IQ being 95, ranging from 82-103. No relationship between the IQ and the type of facies or the size of the lipoma was found. All the children presented psychological alterations, especially misanthropy and shyness. The lipoma was diagnosed by computerised tomography. Two otherwise unidentifiable small lipomas were found with this technique. Pneumoence-phalography and carotid arteriography, which had been performed on nearly all the patients before CT scanning, had demonstrated some alterations. These anomalies slightly deformed the anterior portion of the lateral ventricles and anterior cerebral arteries, but a lipoma in the corpus callosum had not been considered. Only in one case was hypogenesis of the corpus callosum clearly demonstrated. The presence of an extra-osseous lipoma on the forehead and of a vertical bony bar in the intracranial midline in contact with the frontal bone are definite signs of the presence of a lipoma in the corpus callosum. The lipoma is in anterior contact with the vertical bony bar. The neurological alterations presented by the patients in this series are minor compared with those described by other authors writing of children with lipoma of the corpus callosum without FND. Because of mild clinical alteration in these children we have not considered removing the lipoma.

Cerebellopontine angle lipoma

Lipomas rarely occur intracranially. Moreover, the cerebellopontine angle is one of the more unusual sites of such hamartomas. Of the 11 reported cases, all but three caused symptoms related to compression of the cranial nerves in the cerebellopontine angle. Only three separate cases have been studied by computed tomography, and in one the fat density was not recognized. This report deals with the clinical presentations, surgical management, and radiologic assessment of these lesions.

Intracranial teratoma associated with agenesis of the corpus callosum

Several intracranial tumors are known to occur in conjunction with agenesis of the corpus callosum. We report the occurrence of a teratoma with callosal agenesis, an association not previously described, and suggest that the tumor's ventral location may serve to differentiate it from other lesions.

Lipoma of the insula. Case report

The authors present a case of lipoma of the insula. This 20-year-old man with grand mal seizure was diagnosed by computerized tomography, and improved satisfactorily following surgical intervention.

Cephaloceles: clinical and neuroradiological appearance. Associated cerebral malformations

Cephaloceles are congenital malformations with herniation of intracranial structures through a defect in the cranium. On the basis of a review of the literature and 31 personal observations the authors discuss the clinical and neuroradiological presentation of their various anatomical locations: sphenoidal, ethmoidal, frontal, occipital and parietal.

Diagnosis of lipoma of the corpus callosum by CT in five cases

The value of CT in the easy diagnosis of lipomas and associated anomalies of the corpus callosum, thus avoiding angiography and pneumoencephalography, is reported in five cases. An angiogram was performed in only one of the five cases and provided no additional diagnostic information.