Intracranial lipoma

Diagnostic and therapeutic considerations

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✓ Eleven cases of intracranial lipoma, diagnosed during life by computerized tomography (CT) scanning, are presented. Clinical symptoms related to the lesions were present in eight. The CT scan establishes the diagnosis of intracranial lipoma on the basis of typical x-ray absorption and location. Only dermoid cysts and teratomas may produce a similar CT appearance. In cases of intracranial lipoma, a direct surgical approach is seldom necessary, although in certain locations, lipomas may cause blockage of cerebrospinal fluid pathways and require a shunt operation.

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Address reprint requests to: Ekkehard Kazner, M.D., Klinik der Klinikum Charlottenburg der Freien Universitat Berlin, Spandauer Damm 130, 1000 Berlin 19, Federal Republic of Germany.

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Figures

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    Case 1. Lipoma of the left ambient cistern.

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    Case 2. Lipoma overlying the right side of the quadrigeminal plate. View of the tumor in three overlapping computerized tomography slices (lower) and through the operating microscope (upper). The lipomatous nature of the tumor is evident.

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    Case 2. Postoperative computerized tomography scans.

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    Case 3. Lipoma of the quadrigeminal plate (arrows). Severe hydrocephalus was caused by blockage of the aqueduct by the tumor (right pair).

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    Case 4. Contrast computerized tomography scan of a lipoma in the cisterna veli interpositi. The tumor is located adjacent to the internal cerebral vein and sinus rectus (arrow).

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    Case 6. Overlapping computerized tomography slices at 4-mm distance snowing a small lipoma in the chiasmatic cistern, presumably at the infundibulum.

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    Case 7. Multiple intracranial lipomas. Upper: Small lipoma in left part of ambient cistern (arrow, left slice), small lipoma in the anterior portion of the third ventricle (arrow, center left slice), small lipomas at the choroid plexus of both lateral ventricles near the foramen of Monro (arrows, center right slice), and lipomas in the glomus of the choroid plexus bilaterally, causing occlusion of the lateral ventricles (right slice). Extreme dilatation of the temporal and occipital horns and periventricular hypodensity as a sign of transependymal cerebrospinal fluid penetration can be seen. Lower Left: Small lipoma in interpeduncular fossa (CT picture reversed in order to demonstrate the lesion more clearly). Lower Right: Marked regression of ventricular width 6 weeks after drainage operation (artifacts from metal parts of the valve).

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    Case 8. Combination of lipoma of the corpus callosum and lipomas of the choroid plexus of both lateral ventricles. Left Pair: Marked dilatation of the occipital horns. There is agenesis of the corpus callosum. Right Pair: After shunt operation with insertion of ventricular catheter bilaterally from occipital burr holes, there is a significant reduction of ventricular size. The catheter tips are visible on both sides.

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    Case 9. Typical lipoma of the corpus callosum lying between the cerebral hemispheres. The left three scans show shell-like calcifications at the margin of the tumor. There is agenesis of the corpus callosum with considerable separation of the lateral ventricles. Right: Follow-up study after partial removal of the lipoma. The isodense part within the lipoma is probably scar tissue.

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    Case 9. View of the lipoma through the operating microscope, approached through the right side of the interhemispheric fissure. The right pericallosal artery is seen in front of the spatula. The vascularized tumor capsule can be seen.

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    Case 11. Large tabulated lipoma between the frontal lobes, with bone defect in right frontal region. An encephalocele had been removed previously.

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    Case 12. Dermoid cyst originating from the olfactory groove (arrows) and extending to the left frontal area. Upper: The computerized tomography appearance is similar to that of intracranial lipomas due to the very low density. Lower: At low window levels (−10 to −30 Hounsfield units) the non-homogeneous nature of the lesion is clearly visible.

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    Dermoid cyst in the right frontal region. Left Pair: A circular low-density lesion can be seen with delicate calcification at the edge of the cyst. There is concomitant aplasia of the cerebellar vermis. Right Pair: Coronal scans show the defect in the right olfactory groove in front of the sphenoidal jugum (arrow) with the cyst extending into the frontal lobe.

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    Case 14. Dermoid cyst within the third ventricle with a small area of calcification. This patient has severe hydrocephalus.

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    Case 8. Histogram from the center of a lipoma of the corpus callosum (area outlined in Fig. 8). There is homogeneous density with very little standard deviation.

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