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El Marrakchi M, Zian N, Hajhouji F, Laghmari M, Ghannane H, Jallo G, Benali SA. Association of limited dorsal myeloschizis and corpus callosum lipoma: A case report and literature review. Surg Neurol Int 2024; 15:151. [PMID: 38741980 PMCID: PMC11090534 DOI: 10.25259/sni_165_2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 04/08/2024] [Indexed: 05/16/2024] Open
Abstract
Background Intracranial lipomas are a rare clinical entity. These lesions are frequently asymptomatic and originate in the pericallosal area. As they are fat-containing lesions which are intimately attached to the surrounding structures, surgery is not recommended. In some individual reports, subtotal resection is recommended to lessen complications. There have been no previous reports of corpus callosum lipoma (CCL) associated with limited dorsal myeloschizis (LDM). Case Description We describe the case of a combination of CCL and bilateral choroid plexus lipoma discovered incidentally during the investigation of LDM in a 3-month-old male child. Given the asymptomatic behavior of the lipoma and the vascular elements of the pericallosal area, it was decided to monitor it regularly. Thus, the patient underwent surgery only for LDM. Histological examination confirmed the diagnosis, and postoperative follow-up 1 year after showed good evolution. To the best of our knowledge, this association has never been described in the literature. Conclusion This case suggests a possible developmental relationship between CCL and spinal dysraphism.
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Affiliation(s)
- Malak El Marrakchi
- Department of Neurosurgery, Mohammed VI University Hospital Center of Marrakesh, Cadi Ayyad University, Faculty of Medicine, Marrakesh, Morocco
| | - Nahla Zian
- Department of Neurosurgery, Mohammed VI University Hospital Center of Marrakesh, Cadi Ayyad University, Faculty of Medicine, Marrakesh, Morocco
| | - Farouk Hajhouji
- Department of Neurosurgery, Mohammed VI University Hospital Center of Marrakesh, Cadi Ayyad University, Faculty of Medicine, Marrakesh, Morocco
| | - Mehdi Laghmari
- Department of Neurosurgery, Mohammed VI University Hospital Center of Marrakesh, Cadi Ayyad University, Faculty of Medicine, Marrakesh, Morocco
| | - Houssine Ghannane
- Department of Neurosurgery, Mohammed VI University Hospital Center of Marrakesh, Cadi Ayyad University, Faculty of Medicine, Marrakesh, Morocco
| | - George Jallo
- Department of Pediatric Neurosurgery, Institute for Brain Protection Sciences, Johns Hopkins All Children’s Hospital, St. Petersburg, Florida, United States
| | - Said Ait Benali
- Department of Neurosurgery, Mohammed VI University Hospital Center of Marrakesh, Cadi Ayyad University, Faculty of Medicine, Marrakesh, Morocco
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The clinical and radiological features of cisternal and pericallosal lipomas. Acta Neurol Belg 2020; 120:65-70. [PMID: 30868467 DOI: 10.1007/s13760-019-01119-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 03/06/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE To demonstrate the clinical and radiological features of pericallosal and cisternal lipomas and to compare these two groups in terms of radiological and clinical features. METHODS This retrospective study included 23 patients diagnosed with pericallosal and cisternal lipoma between 2010 and 2017. The patients comprised 12 females and 11 males with a mean age of 38.8 years (range 12-69 years). Magnetic resonance imaging was applied to all the patients. Computed tomography (CT) was also performed in 10 patients. RESULTS 9 lesions were pericallosal and 14 were cisternal (7 were right quadrigeminal cistern, 3 were left quadrigeminal cistern, 1 was interpeduncular cistern, 1 was left cerebellopontine cistern, 1 was right cerebellopontine cistern, and 1 was supracerebellar cistern). The mean size of the lesions was 18.7 ± 10 mm. The shape of the lesions was curvilinear in 10 patients (43.5%) and tubulonodular in 13 patients (56.5%). The mean CT density of the lesions was - 87.7 ± 25.6 HU. The size of pericallosal lipomas (mean 27.5 mm) was statistically significantly larger than that of cisternal lipomas (mean 13.1 mm) (p = 0.001). No statistically significant difference was determined between the two groups in terms of lesion shape (p = 0.478), gender (p = 0.707), age (p = 0.639), and symptoms (p = 0.084). CONCLUSIONS In this study, the incidence of pericallosal lipomas was 0.011% and the incidence of cisternal lipomas was 0.017%. Although rare, the knowledge of the clinical and radiological features of pericallosal and cisternal lipomas will play an important role in the accurate diagnosis and follow-up of the patient.
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Evaluating the utility of a scoring system for lipomas of the cerebellopontine angle. Acta Neurochir (Wien) 2017; 159:739-750. [PMID: 28110401 DOI: 10.1007/s00701-017-3076-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 01/04/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Cerebellopontine angle (CPA) lipomas are rare, benign, slow-growing masses. Resections are considered in symptomatic patients who are refractory to targeted medical therapies, but at those stages the lipomas have often reached considerable sizes and encompass critical neurovascular structures. The objective of this study is to develop and to evaluate the utility of a scoring system for CPA lipomas. The hypothesis is that CPA lipomas with lower scores are probably best managed with early surgery. METHODS The PubMed database was searched using relevant terms. Data on patient and lipoma characteristics were extracted and used to design a scoring system. CPA lipomas were stratified by scores with corresponding managements and outcomes analyzed. RESULTS One hundred and seventeen patients with CPA lipomas were identified and 40 CPA lipomas were scored. The remaining CPA lipomas were deficient in data and not scored. No lipomas were scored as 1. Score 2 lipomas (n = 12; 30%) most often underwent serial surveillances (n = 5; 41.6%), with the majority of symptoms remaining unimproved (n = 2; 40%). Patients with score 2 CPA lipomas treated with medical therapies (n = 3; 25%) often experienced symptom resolution (n = 2; 66.6%) (p = 0.0499). Patients with score 2 CPA lipomas undergoing surgical resections (n = 3; 25%) all experienced symptom resolution (n = 3; 100%) (p = 0.0499). Score 3 was most common (n = 16; 40%) and these lipomas were often surgically resected (n = 10; 62.5%). The majority of patients with score 3 CPA lipomas having undergone surgical resections (n = 10; 62.5%) experienced symptom improvement (n = 1; 10%) or resolution (n = 4; 40%). CONCLUSIONS Score 2 CPA lipomas are smaller and would be deemed non-surgical in general practice. However, our data suggest that these lipomas may benefit from either medical therapies or early surgical resections. The advantages of early surgery are maximal resection, decreased surgical morbidity, and improved symptom relief.
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Baskan O, Geyik S. Frontal lobe lipoma associated with cortical dysplasia and abnormal vasculature. Neuroradiol J 2014; 27:671-5. [PMID: 25489889 DOI: 10.15274/nrj-2014-10082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Accepted: 08/04/2014] [Indexed: 11/12/2022] Open
Abstract
Intracranial lipomas (ICLs) are rare lesions, the vast majority encountered as incidental findings on imaging studies. ICLs are generally pericallosal midline lesions and thought to be asymptomatic and can be accompanied by additional intracranial congenital malformations. We describe a 17-year old male with an unusual case of ICL on the frontal lobe associated with cortical dysplasia and abnormal vasculature mimicking arteriovenous malformation on magnetic resonance images.
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Affiliation(s)
- Ozdil Baskan
- Department of Radiology, Istanbul Medipol University School of Medicine; Istanbul, Turkey -
| | - Serdar Geyik
- Department of Radiology, Istanbul Medipol University School of Medicine; Istanbul, Turkey
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Venkataramana N, Rao SAV, Naik AL, Chaitanya K, Murthy P. Cerebello pontine angle lipoma in a child. J Pediatr Neurosci 2012; 7:75-7. [PMID: 22837790 PMCID: PMC3401666 DOI: 10.4103/1817-1745.97635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Neelam Venkataramana
- Department of Neurosurgery, Advanced Neuro Science Institute, BGS Global Hospital, Bangalore, Karnataka, India
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Schuhmann MU, Lüdemann WO, Schreiber H, Samii M. Cerebellopontine angle lipoma: a rare differential diagnosis. Skull Base Surg 2011; 7:199-205. [PMID: 17171031 PMCID: PMC1656654 DOI: 10.1055/s-2008-1058596] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Intracranial lipomas in an infratentorial and extra-axial location are extremely rare. The presented case of an extensive lipoma of the cerebellopontine angle (CPA) represents 0.05% of all CPA tumors operated on in our department from 1978 to 1996. The lipoma constitutes an important differential diagnosis because the clinical management differs significantly from other CPA lesions. The clinical presentation and management of the presented case are analyzed in comparison to all previously described cases of CPA lipomas. The etiology and the radiological features of CPA lipomas are reviewed and discussed. CPA lipomas are maldevelopmental lesions that may cause slowly progressive symptoms. Neuroradiology enables a reliable preoperative diagnosis. Attempts of complete lipoma resection usually result in severe neurological deficits. Therefore, we recommend a conservative approach in managing these patients. Limited surgery is indicated if the patient has an associated vascular compression syndrome or suffers from disabling vertigo.
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Barajas RF, Chi J, Guo L, Barbaro N. MICROVASCULAR DECOMPRESSION IN HEMIFACIAL SPASM RESULTING FROM A CEREBELLOPONTINE ANGLE LIPOMA. Neurosurgery 2008; 63:E815-6; discussion E816. [DOI: 10.1227/01.neu.0000325734.30302.97] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
ABSTRACTOBJECTIVEHemifacial spasm caused by a cerebellopontine angle lipoma is extremely rare. We describe a patient with left-sided hemifacial spasm caused by vascular compression of the facial and vestibulocochlear cranial nerves by the anteroinferior cerebellar artery embedded within a cerebellopontine angle lipoma.CLINICAL PRESENTATIONA 77-year-old man presented with a 10-year history of left-sided facial spasms that progressively worsened over time and significantly interfered with his ability to read, drive, and interact in social situations. Neurological examination showed obvious left hemifacial spasm, including orbicularis oculi and levator labii muscles. Magnetic resonance imaging revealed characteristic abnormal signal within the cerebellopontine angle cistern that was consistent with lipoma abutting the anteroinferior cerebellar artery.INTERVENTIONSurgical exploration with standard retrosigmoid craniectomy and subarachnoid dissection of the cerebellopontine angle was performed. The offending anteroinferior cerebellar artery branch was dissected away from the VIIth and VIIIth cranial nerves. Teflon felt was interposed between the artery and nerves after the artery was dissected off the surface of the lipoma. Electrophysiological monitoring showed resolution of the abnormal hemifacial spasm response during the procedure. No attempt was made to resect the lipoma, given the risk to injury of the brainstem and perforating blood vessels. Postoperatively, the patient's symptoms were completely resolved.CONCLUSIONThis case demonstrates that relief of the vascular compression, when present, of the VIIth cranial nerve is sufficient for resolution of hemifacial spasm symptoms, even when associated with nearby, benign lesions.
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Affiliation(s)
- Ramon F. Barajas
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - John Chi
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - Lanjun Guo
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - Nicholas Barbaro
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
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Iplikcioglu C, Bikmaz K, Gokduman CA, Bek S. Cerebellopontine angle lipoma with extracranial extension. J Clin Neurosci 2006; 13:1045-7. [PMID: 17113988 DOI: 10.1016/j.jocn.2006.01.045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2005] [Accepted: 01/16/2006] [Indexed: 10/23/2022]
Abstract
Lipomas of the cerebellopontine angle (CPA) are rare. A recent literature review identified only 98 reported cases of CPA lipoma. We present here a case of CPA lipoma in a 28-year-old woman who was admitted to our hospital with hearing loss in her left ear. Computed tomography scan and magnetic resonance imaging revealed a CPA mass lesion with extracranial extension around the left internal carotiol artery. The patient was operated on in the sitting position via a right suboccipital craniectomy. The intracranial part of the mass was partially removed. Histopathological examination resulted in a diagnosis of lipoma. Surgical treatment of CPA lipomas is rarely indicated, and the aim of surgery must be decompression of neural structures.
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Affiliation(s)
- Celal Iplikcioglu
- Neurosurgery Clinic, Social Security Okmeydani Teaching Hospital, Istanbul, Turkey
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Loddenkemper T, Morris HH, Diehl B, Lachhwani DK. Intracranial lipomas and epilepsy. J Neurol 2006; 253:590-3. [PMID: 16767540 DOI: 10.1007/s00415-006-0065-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2005] [Revised: 10/19/2005] [Accepted: 10/21/2005] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Intracranial lipomas are rare, mostly congenital lesions. Sporadic case reports suggest an association with focal epilepsy. METHODS All admissions to our epilepsy monitoring unit who had had brain MRI were reviewed for intracranial lipomas during 6 consecutive years. RESULTS Five patients with intracranial lipomas were identified (0.14%). Lipomas were located in the midline (3 cases), in the tectal region, and over the parietal cortex. Another intracranial pathology was identified in two patients causing the epilepsy in these cases (head trauma and hemimegaencephaly). In two other cases the Video EEG monitoring findings were not congruent with the location of the lipoma, but no other explanation for their epilepsy was found. In one patient a large midline lipoma extending into the right lateral ventricle was thought to be the cause of the patient's right hemispheric seizures. No other clinical symptoms or complications of the lipomas were noted. DISCUSSION Intracranial lipomas are rare, incidental, often asymptomatic findings and usually located near the midline. In only one of our five patients was the lipoma interpreted as the definite cause of the epilepsy.
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Affiliation(s)
- Tobias Loddenkemper
- Section of Epilepsy, The Cleveland Clinic Foundation, 9500 Euclid Ave, S-51, Cleveland, OH 44195, USA.
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Ahmetoğlu A, Aynaci FM, Sari A. Sylvian fissure lipoma associated with cortical dysplasia and abnormal vascularity. ACTA ACUST UNITED AC 2003. [DOI: 10.1016/s1571-4675(03)00042-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Feldman RP, Marcovici A, LaSala PA. Intracranial lipoma of the sylvian fissure. Case report and review of the literature. J Neurosurg 2001; 94:515-9. [PMID: 11235959 DOI: 10.3171/jns.2001.94.3.0515] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The authors present a rare case of lipoma of the sylvian fissure found in a 34-year-old man who presented with seizures. The patient underwent craniotomy and an attempted resection of the lesion, which was initially believed to be a dermoid tumor. The imaging characteristics of dermoids and lipomas are extremely similar. Given the difference in the natural history and resectability of these lesions, lipomas should be included in the differential diagnosis of lesions with imaging characteristics similar to dermoids. Currently, tumor location, density of the lesion or computerized tomography scans, and signal homogeneity of the lesion on magnetic resonance images can help one to distinguish these radiographically similar, but pathologically different, entities. As this case confirms, resection of a sylvian fissure lipoma is extremely difficult and potentially dangerous; in addition it is unlikely to improve symptoms. A short review of 10 cases reported in the literature and therapeutic options for these lesions are also discussed.
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Affiliation(s)
- R P Feldman
- Department of Neurological Surgery, Albert Einstein College of Medicine, Bronx, New York, USA.
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Abstract
We present the first case of cortical dysplasia with extensive intracerebral ossification. An eight-year-old epilepsy patient with a calcified lesion was successfully treated by surgical intervention. Pathological examination revealed a number of bizarre dysplastic cells in the whole lesion, which consisted of an epileptogenic cerebral cortex and a nonepileptogenic hamartomatous lesion with adipose tissue, vascular tissue, calcification, and ossification. The patient was diagnosed as having cortical dysplasia with ossification. Our findings support the notion that cortical dysplasia has a multipotentiality of cellular differentiation, including various hamartomatous tissues. We suggest that cortical dysplasia should be considered as a potential cause for epileptogenicity of a hamartomatous lesion even when magnetic resonance imaging (MRI) fails to disclose cortical dysplasia.
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Affiliation(s)
- T Maehara
- Tokyo Metropolitan Neurological Hospital, Departments of Neurosurgery, Neuroradiology, and Pathology, Fuchu, Tokyo, Japan.
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Truwit C. MRI findings in 32 consecutive lipomas using conventional and advanced sequences. J Neuroimaging 2000; 10:190-1. [PMID: 10918751 DOI: 10.1111/jon2000103190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Hädecke J, Buchfelder M, Triebel HJ, Schneyer U. Multiple intracranial lipoma: a case report. Neurosurg Rev 1998; 20:282-7. [PMID: 9457725 DOI: 10.1007/bf01105901] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
We report on a male epileptic patient, presently 27 years old, who has suffered complex-partial attacks for 19 years. Under treatment with carbamazepine the seizures were completely controlled. In addition, the patient exhibited partial hypopituitarism. CT and MRI revealed the presence of 2 lipomas, one located within the optico-chiasmatic cistern and the other one in the medial temporal lobe. To our knowledge, this combination of the generally rare lesions has not been described yet.
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Affiliation(s)
- J Hädecke
- Department of Internal Medicine, Martin Luther University, Halle-Wittenberg, Fed. Rep. of Germany
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Abstract
An extremely rare case of lipomas on the cerebral surface in a 65-year-old female is reported. The tumors were located both in an unusual fissure of the right frontal convexity and under the right frontal lobe associated with and surrounded by areas of focal cortical dysplasia. Angiograms revealed dilated branches of the right anterior cerebral artery associated with angiomatous tumor blushes. The etiology of the combination of the lipomas and the anomalies, and the angiographic features, are briefly discussed.
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Affiliation(s)
- H Sasaki
- Department of Neurosurgery, School of Medicine, Keio University, Tokyo, Japan
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