Central Nervous System Lipomas.

Abstract

The lipomas of the central nervous system are rare lesions of congenital origin and are located in the medial line and especially in corpus callosum. Intramedullary spinal lipomas can be seen in the life span of 30 years of age and most frequently coincide with initial puberty period. Magnetic resonance imaging and computerized tomography together with clinical trials are of crucial importance for diagnosis. The first case: A two-year-aged girl who had lipoma in quadrigeminal cistern and who suffered from encephalocraniocutaneous lipomatosis has been clinically studied. The fascial lipoma of the patient has been excised subtotally by the Plastic Surgeons; then the patient has underwent supracerebellar infratentorial operation where the intracranial lipoma has been excised by our team. The histopathology has been reported to be consisting of peripheric nerve tissue and calcification. The second case: A twenty-year-aged man with intramedullary lipoma localized between T1-T4 has been given our clinical trials. T1-T5 total laminectomy and subtotal excision were made for this patient. Due to the fact that the lipomas of central nervous system are rarely seen and are involved in nervous and calcific tissues except for fatty tissues they can be mistaken for hamartomatous masses. The total excision of the lipomas of central nervous system and especially the spinal intramedullary lipomas are quite difficult to be excised since they are tightly entangled with the neural tissue. So any attempt for total excision would be dangerous. Operation for decompression and biopsy is of primary concern.

Role of intraoperative squash smear cytology as a diagnostic modality in lipoma of quadrigeminal cistern

“…Intracranial lipomas may be included within the spectrum of developmental malformations rather than a hamartoma or true neoplasm. [1,2] These lesions originate from mesodermal germ plaque beneath the leptomeninges, [1] or may be a result of abnormal persistence and mal-differentiation of meninx primitiva during the development of the subarachnoid cisterns. [2] Heterotopic components like cartilage, bone described in these lipomas, [6] along with its association with other brain anomalies in almost half of the cases lends support to a developmental malformation.…”

“…Complete excision is usually attempted, though at times close proximity to or dense adhesions with vital structures allow only partial removal. [1,4,5] This child required surgery as the lesion was causing pressure effect on the midbrain. Intraoperatively, a tiny residual tumor mass in close proximity to the superior cerebellar artery was left behind.…”

“…Intracranial lipomas are rare brain tumors with an incidence of 0.06-0.3%. [1] These tumors tend to occur in characteristic locations like interhemispheric (approximately 50%), quadrigeminal or superior cerebellar cistern (10-25%), suprasellar or interpeduncular cistern, cerebellopontine angle, and sylvian fissure. [2,3] Almost half of the intracranial lipomas are asymptomatic, and frequently manifest in young adult age group.…”

“…[2,3] Almost half of the intracranial lipomas are asymptomatic, and frequently manifest in young adult age group. [1] Quadrigeminal cistern, also known as superior cistern or cistern of the great cerebral vein is one of the subarachnoid cisterns located between the splenium of the corpus callosum and the superior surface of the cerebellum. It extends from the third ventricle to the great cerebral vein.…”

Spinal Cord Calcification in an Early-Onset Progressive Leukoencephalopathy

“…Many forms of leukoencephalopathy can present with intracranial calcifications, 12 but the spinal cord has never been reported as a site of calcium deposits. Spinal cord calcifications are, instead, reported in tumoral diseases, [2][3][4][5][6] usually within the tumor mass itself.…”