Lipomas of the pineal region

Abstract

Background Intracranial lipomas are rare lesions, representing 0.02% of operated intracranial lesions. Lipomas of the pineal region are even rarer and are reported occasionally in the literature. This is possibly because of the fact that they may give rise to clinical symptoms rather infrequently. When they become symptomatic, some form of management must be contemplated. Methods Four cases of lipomas of the pineal region observed in our institute during a 5-year period were investigated, and clinical-diagnostic features were studied. Two of the cases were symptomatic and were submitted to direct surgical treatment. Results Computed tomography (CT) scanning was performed in 3 cases and magnetic resonance imaging (MRI) in all 4. MRI angiography was performed in the last case. The appearance of the lipoma was quite pathognomonic in the neuroimaging diagnostic test. The infiltrative character of the lesion was better defined by MRI. MRI angiography gave evidence of the upward displacement of the deep veins. Direct surgical approach was performed via a right occipital transtentorial approach in one case and supracerebellar route in another. Neither approach appeared to be superior to the other one. Total removal of the lesion seemed to be impossible because of the infiltrative character of the lesion. Postoperative results were satisfactory even with incomplete removal of the lesion. Conclusion Lipomas of the pineal region are rare. Modern neuroimaging permits a straightforward diagnosis of the nature of intracranial lipomas in general and of these lipomas in particular. Some form of management must be contemplated when these lesions become symptomatic. Direct surgical approach, either via an occipital transtentorial or an infratentorial supracerebellar approach, is feasible. Tumor removal must be dealt with cautiously because total removal is impossible without unacceptable postoperative deficits, and generous partial removal warrants long-term symptomatic improvement.