Type:
Educational Exhibit
Keywords:
Neuroradiology brain, CT, MR, Diagnostic procedure, Congenital, Tissue characterisation
Authors:
N. Fileva, J. D. Dimova, D. Zlatareva, V. Hadjidekov; Sofia/BG
DOI:
10.26044/ecr2019/C-2981
Background
Intracranial lipomas are rare lesions (0.06-0.46% of all intracranial tumors) and can be located anywhere in the intracranial compartment,
although they have a predilection to develop near the midline of falx cerebri over the corpus callosum.
Other reported cases with different locations include cerebellopontine angle (CPA),
the quadrigeminal cerebellar cistern,
the choroid plexus of the ventricles,
cerebellum,
insula,
chiasmatic cistern,
etc.
In some cases there might be intra and extracranial components,
connected to each other by fibrous-lipomatous stalk.
There are many theories of the pathogenesis of the intracranial lipomas,
beginning more than 150 years ago.
- Virchov (1863) – hypertrophy of preexisting fatty tissue of the meninges
- Verga (1929) – development disorder of the embryologic meninx primitive,
regarded as a tumor
- Krainer – abnormal,
persistent focus of meninx primitive with nonneoplastic behavior
- Osaka – included the role of the creation of the subarachnoid cisterns
- Barkovich (1990) – summarized the last theories to abnormal persistence and maldifferentiation of meninx primitive during the development of the subarachnoid cisterns
Generally intracranial lipomas are asymptomatic lesions and are reported as incidental findings.
Often they are associated with other brain malformations or vascular abnormalities that could be the reason of the performing the exam – most common of them are agenesis or digenesis of corpus callosum.
In rare cases,
there might be symptoms caused by the lipoma,
depending on its location – most common clinical manifestations include headache and seizures,
less common – motor impairment,
obesity,
tinnitus.
The asymptomatic patients do not require treatment.
In cases of headaches and seizures noninvasive symptomatic approaches are preferred.
Radical surgical excision is an option,
but is technically difficult,
due to the highly vascularization of the tumors and capsular adhesions to the surrounding brain.