A Clinical Case Report About an Intracranial Lipoma

Abstract

Intracranial lipoma is a uncommon congenital malformation, represent less than 0.1% of all intracranial tumors. Result from abnormal persistence and mal-differentiation of meninx primitiva, during embryogenesis. The cases in which the tumor presents an extracranial component are caused by a secondary dehiscence of the skull with evagination of a small tuft of primitive meninges. These lesions are frequently located in the inter-hemispheric fissure in the pericallosal region in 50% of cases, other locations as ambient or quadrigeminal cisterns present an incidence about 20-25%. In half of cases the patients present associate midline brain malformations of varying severity, the most frequent is the agenesia of the corpus callosus. The most accepted theory states that in embryonic phases, mesenchymal alterations at the level of the cranial sutures in the sagittal plane can cause anomalies of the SSS, sinus rectum, tentorium, and parietal bones that would explain the associated anomalies. Majority of intracranial lipomas are detected incidentally, being a third of the asymptomatic cases. As in all other pathologies certain localizations cause specific symptomatology of the involved area. The most common clinical manifestations are headache, epilepsy, mental dysfunctions and cranial nerve deficits. The clinical diagnosis is unclear and it is necessary release complementary exams in every suspected cases. Neuroimaging studies such as computed tomography (CT) or magnetic resonance imaging (MRI) make possible identify these lesions. We describe a clinical case about a 79-year-old woman with headache without any other symptoms. Was done CT and MRI that showed a inter-hemispheric lesion located in the pericallosal region, without any other abnormality associated. The development, during the last decades, of neuroimaging and histogenesis techniques increased the knowledge about this pathology and modified the management in recent times. The surgery is contraindicated in the majority of the cases, however still play a role in some cases especially in presence of hydrocephalus, uncontrollable seizures, and bony affectation with cosmetic influence. The medical control of the epilepsy is mandatory. We present a clinical case about pericallosal intracranial lipoma and review the current literature. Taking in account the clinical situation and the imaging findings, we decide for a conservative approach with clinical/neurological and radiological follow-up.