Intracranial lipoma of the sylvian fissure

Case report and review of the literature

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✓ 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.

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Figures

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    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.

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    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).

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

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