A rare case of quadrigeminal plate lipoma presenting with the sixth cranial nerve palsy

Abstract

Intracranial lipomas are rare benign tumour that is slow growing, generally asymptomatic, most frequently located in the midline areas and are usually an incidental finding on imaging and therefore cases are not frequently reported. This study reports a case of a patient with quadrigeminal plate lipoma presenting with obstructive hydrocephalous and the 6th cranial nerve palsy that was successfully treated with ventriculo-peritoneal shunting without addressing the lesion. Key words: Lipoma, quadrigeminal plate, the 6th cranial nerve palsy, hydrocephalus ABSTRACTArticle history:

Giant Quadrigeminal Cistern Lipoma: A Case Report and Literature Review

“…[1][2][3][4][5][6][7] There are a lot of theories about the origin of these lesions, and the prevalent hypothesis suggests that its etiology is related to inadequate development of the primitive meninges. [1][2][3][4][6][7][8][10][11][12] In addition, there is an inadequate development of the subarachnoid spaces. 7 This condition allows that nerves and vessels pass through the tumors.…”

“…1,2,4,5,[7][8][9]11 In MRI, in T1-weighted sequence, lipomas appear in hypersignal, whereas in T2, they present isohypointensity. 1,2,[4][5][6][7][8][9][10][11][12] In a fat-sat T2 sequence, there is a homogeneous decrease in the lipoma region, due to its abundant adipose content.…”

“…Dermoid tumors, however, unlike lipomas, may not be homogeneous on resonance, due to the presence of skin and hair. 1 2 4 5 7 9 12…”

“…In this context, surgery to remove the tumor is usually performed in severely symptomatic patients, in order to prevent neurological deterioration. 1 2 4 6 8 10 11 12 In individuals with severe hydrocephalus secondary to lipoma obstruction, for example, it is possible to perform a bypass surgery in order to relieve symptoms, 2 while in those who have a marked mass effect, a resection of the tumor 1 can be chosen. 2 4 6 8 10 11 12…”

“…1,2,[8][9][10][11] Its origin is related to inadequate embryonic development, due to the involution of the primitive meninge [1][2][3][4][6][7][8][10][11][12] commonly associated with other congenital malformations. 1,[3][4][5][6][7][8][9][10][11][12] These lesions are generally asymptomatic, due to slow growth, 1,[4][5][6][8][9][10][11][12] so that differentiation to a malignant character has never been reported. 1 The fact that the majority of those who have intracranial lipomas do not present symptoms makes the diagnosis difficult, causing it to occur accidentally, often among patients who have other pathologies.…”