Intracranial interhemispheric osteochondrolipoma: Diagnostic and surgical challenges in an extremely rare entity

Abstract

Intracranial lipomas are rare developmental lesions, predominantly occurring in the interhemispheric location. Osteochondrolipoma is an extremely rare variant of lipoma with osseous and chondroid differentiation. We present a case of interhemispheric osteochondrolipoma, in a 2.5-years-old male child which was detected antenatally, in association with corpus callosum agenesis. The lesion progressively increased in size with resulting compression of surrounding structures, and was subjected to microsurgical decompression. To the best of our knowledge, this is the first case of intracranial interhemispheric osteochondrolipoma in the existing medical literature. Peculiarities of this case and the diagnostic and surgical challenges are discussed.

Headaches and Increased Growth Percentiles in a 5-Year-Old Male

“…18 Risks of bleeding and potentially associated vascular malformations are further dangers encountered in these procedures. 2 The present case and historical data detailing intervention for intracranial lipomas illustrate the importance of careful workup and utility of conservative management strategies in intracranial osteolipomas, which are rare congenital malformations posing challenging diagnostic and management decisions for the pediatric provider. This case also illustrates an opportunity to engage a family in addressing long-standing health risk factors in childhood, such as poor dietary habits, poor sleep hygiene, and passive smoke exposure, that while difficult to correct are much less scary to deal with than an intracranial tumor can be.…”

“…It is hypothesized that normal postnatal growth of adipose tissue can be paralleled by growth of intracranial lipomas, or that growth factors or signaling pathway abnormalities may be involved in progression of these lesions. 2,3 Significant growth of this intracranial lesion has complicated diagnosis and management choices. These tumors are commonly well vascularized, attached to adjacent tissues, and usually located near the tuber cinereum.…”

“…3 Rajeshwari et al noted significant diagnostic and management challenges due to growth of an intracranial lipoma over 2 years after being first imaged on prenatal ultrasound. 2 Given these diagnostic challenges, it is important to determine an efficacious management strategy of these rare tumors. Our case illustrates a series of findings commonly reported in symptomatic intracranial osteolipoma literature that was found to be unrelated after extensive workup.…”

“…18 Risks of bleeding and potentially associated vascular malformations are further dangers encountered in these procedures. 2…”

“…6 Diagnosis can be made either through MRI or computed tomography, which commonly reveal peripheral calcification. 2 The most common symptoms reported include seizures and headaches. 16 One retrospective study of 20 patients with intracranial lipomas had a mean age of presentation of 5.3 years.…”