Intracranial lipoma of the sylvian fissure

Case report and review of the literature

Restricted access

✓ 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.

Article Information

Address reprint requests to: Robert P. Feldman, M.D., Department of Neurological Surgery, Montefiore Medical Center, 111 East 210th Street, Bronx, New York 10461. email: rpfeld@aol.com.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Axial noncontrast-enhanced CT scan revealing a 2.5 × 1.0 × 2.5—cm mass in the right sylvian fissure and extending to the insula. No surrounding edema or mass effect is present. The lesion is markedly hypointense to both brain and cerebrospinal fluid and two small areas of focal hyperintensity consistent with calcium can be observed on the medial and lateral walls of the mass. The density of the lesion is consistent with fat or air.

  • View in gallery

    Axial magnetic resonance images revealing a 2.6 × 1 × 2.5—cm lobular homogeneous mass located in the right sylvian fissure and abutting but not invading the right insular cortex. There is mild surrounding mass effect but no edema. The lesion demonstrates a markedly high signal intensity on noncontrast-enhanced T1-weighted images (left), but does not demonstrate significant enhancement on gadolinium-enhanced T1-weighted images (data not shown). On T2-weighted images (center), the lesion demonstrates a signal intensity that is slightly lower than that of cerebrospinal fluid. On fat-suppression images (right), the mass demonstrates a low signal. The intricate involvement of the proximal branches of the right MCA are evident as flow voids on the T2-weighted (center) and fat-suppression images (right).

  • View in gallery

    Photomicrograph of lipoma surrounded by fibrous tissue with several blood vessels. H & E, original magnification ×40.

References

1.

Britt PMBindal AKBalko MGet al: Lipoma of the cerebral cortex: case report. Acta Neurochir 121:88921993Britt PM Bindal AK Balko MG et al: Lipoma of the cerebral cortex: case report. Acta Neurochir 121:88–92 1993

2.

Cohen TIPowers SKWilliams DW III: MR appearance of intracanalicular eighth nerve lipoma. AJNR 13:118811901992Cohen TI Powers SK Williams DW III: MR appearance of intracanalicular eighth nerve lipoma. AJNR 13:1188–1190 1992

3.

Cserni G: Intracranial lipoma of the Sylvian region. Neuropathol Appl Biol 19:2822851993Cserni G: Intracranial lipoma of the Sylvian region. Neuropathol Appl Biol 19:282–285 1993

4.

Dragojević SMehraein PBock HJ: Beobachtung eines lipoms der temporal region mit Rindenmißbildung und Epilepsie. Arch Psychiat Nervenkr 217:3353421973Dragojević S Mehraein P Bock HJ: Beobachtung eines lipoms der temporal region mit Rindenmißbildung und Epilepsie. Arch Psychiat Nervenkr 217:335–342 1973

5.

Dyck P: Sylvian lipoma causing auditory hallucinations: case report. Neurosurgery 16:64671985Dyck P: Sylvian lipoma causing auditory hallucinations: case report. Neurosurgery 16:64–67 1985

6.

Fukui MTanaka AKitamura Ket al: Lipoma of the cerebellopontine angle. Case report. J Neurosurg 46:5445471977Fukui M Tanaka A Kitamura K et al: Lipoma of the cerebellopontine angle. Case report. J Neurosurg 46:544–547 1977

7.

Futami KKimura AYamashita J: Intracranial lipoma associated with cerebral saccular aneurysm. Case report. J Neurosurg 77:6406421992Futami K Kimura A Yamashita J: Intracranial lipoma associated with cerebral saccular aneurysm. Case report. J Neurosurg 77:640–642 1992

8.

Halmagyi GMEvans WA: Lipoma of the quadrigeminal plate causing progressive obstructive hydrocephalus. Case report. J Neurosurg 49:4534561978Halmagyi GM Evans WA: Lipoma of the quadrigeminal plate causing progressive obstructive hydrocephalus. Case report. J Neurosurg 49:453–456 1978

9.

Hatashita SSakakibara TIshii S: Lipoma of the insula. Case report. J Neurosurg 58:3003021983Hatashita S Sakakibara T Ishii S: Lipoma of the insula. Case report. J Neurosurg 58:300–302 1983

10.

Kazner EStochdorph OWende Set al: Intracranial lipoma: diagnostic and therapeutic considerations. J Neurosurg 52:2342451980Kazner E Stochdorph O Wende S et al: Intracranial lipoma: diagnostic and therapeutic considerations. J Neurosurg 52:234–245 1980

11.

Krainer L: Die Hirn- und Rückenmarkslipome. Virchows Arch Pathol Anat 295:1071421935Krainer L: Die Hirn- und Rückenmarkslipome. Virchows Arch Pathol Anat 295:107–142 1935

12.

Maiuri FCirillo SSimonetti L: Lipoma of the sylvian region. Clin Neurol Neurosurg 91:3213231989Maiuri F Cirillo S Simonetti L: Lipoma of the sylvian region. Clin Neurol Neurosurg 91:321–323 1989

13.

Maiuri FCirillo SSimonetti Let al: Intracranial lipomas. Diagnostic and therapeutic considerations. J Neurosurg Sci 32:1611671988Maiuri F Cirillo S Simonetti L et al: Intracranial lipomas. Diagnostic and therapeutic considerations. J Neurosurg Sci 32:161–167 1988

14.

Osborn AG (ed): Diagnostic Neuroradiology. St. Louis: Mosby1994 pp 636639Osborn AG (ed): Diagnostic Neuroradiology. St. Louis: Mosby 1994 pp 636–639

15.

Rubinstein LJ: Atlas of Tumor Pathology Second Series Fascicle 6. Tumors of the Central Nervous System. Washington DC: Armed Forces Institute of Pathology1972 pp 401469Rubinstein LJ: Atlas of Tumor Pathology Second Series Fascicle 6. Tumors of the Central Nervous System. Washington DC: Armed Forces Institute of Pathology 1972 pp 401–469

16.

Scherer E: Über die pialen lipome des Gehirns. Beitrag eines Falles von ausgedehnter meningealer Lipomatose einer grosshirnhemisphäre bei Mikrogyrie. Z Neurol 154:45611935Scherer E: Über die pialen lipome des Gehirns. Beitrag eines Falles von ausgedehnter meningealer Lipomatose einer grosshirnhemisphäre bei Mikrogyrie. Z Neurol 154:45–61 1935

17.

Schwesinger GWarzok RSchneider D: Lipomatöses Hamartom des Grosshirns. Beitrag zur Problematik der intrakraniellen Lipome. Zentralbl Allg Pathol Anat 126:29341982Schwesinger G Warzok R Schneider D: Lipomatöses Hamartom des Grosshirns. Beitrag zur Problematik der intrakraniellen Lipome. Zentralbl Allg Pathol Anat 126:29–34 1982

18.

Truwit CLBarkovich AJ: Pathogenesis of intracranial lipoma: an MRI study in 42 patients. AJR 155:8558641990Truwit CL Barkovich AJ: Pathogenesis of intracranial lipoma: an MRI study in 42 patients. AJR 155:855–864 1990

19.

Von Rokintansky C: Lehrbuch der Pathologischen Anatomie. Vienna: Wilhelm Braumüller Vol 21842 pp 468470Von Rokintansky C: Lehrbuch der Pathologischen Anatomie. Vienna: Wilhelm Braumüller Vol 2 1842 pp 468–470

20.

Yalcin SFragoyannis S: Intracranial lipoma. Case report. J Neurosurg 24:8958961966Yalcin S Fragoyannis S: Intracranial lipoma. Case report. J Neurosurg 24:895–896 1966

TrendMD

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 13 13 11
Full Text Views 72 72 18
PDF Downloads 86 86 22
EPUB Downloads 0 0 0

PubMed

Google Scholar