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Published on: August 11, 2015
[Intracranial lipomas in paediatrics: a retrospective study of 20 patients]
F A Gómez-Gosálvez1, F Menor-Serrano, M Téllez de Meneses-Lorenzo
1Servicio de Pediatría, Hospital Virgen de los Lirios, Alcoy, Alicante, España. fagomezgos@coma.es
Insights
Intracranial lipomas (ICL) are congenital malformations often found incidentally. Psychomotor retardation and headaches are the most frequent symptoms in children, with common locations including the interhemispheric fissure and quadrigeminal cistern.
Area of Science:
- Neuroscience
- Developmental Biology
- Radiology
Context:
- Intracranial lipomas (ICL) are rare congenital malformations arising from primitive meninges.
- Understanding their clinical presentation, location, and associated anomalies is crucial for diagnosis and management.
- Paediatric ICL cases require specific evaluation due to developmental implications.
Purpose:
- To identify the most common symptoms of paediatric intracranial lipomas.
- To assess the relationship between ICL location, symptoms, and co-occurring brain malformations.
- To evaluate the diagnostic and prognostic significance of ICL in children.
Summary:
- A retrospective study of 20 paediatric patients revealed ICL predominantly in the interhemispheric fissure and quadrigeminal cistern.
- Psychomotor retardation (40%) and headaches (30%) were the most frequent symptoms; epilepsy was rare (5%).
- Associated anomalies, particularly corpus callosum and septum pellucidum defects, occurred in 40% of cases.
Impact:
- ICL are often incidental findings, with symptoms like psychomotor retardation and headaches being most prevalent.
- The study highlights that ICL are developmental anomalies not typically requiring neurosurgical intervention.
- Findings underscore the importance of considering associated brain malformations in paediatric ICL cases.
Introduction:
Intracranial lipomas (ICL) are congenital malformations that are due to an anomalous differentiation of the primitive meninges.
Aims:
The purpose of this study is to determine the most frequent symptoms related to ICL in the paediatric age, as well as to evaluate whether they are directly related to their location and to their association with other brain malformations.
Patients And Methods:
A retrospective clinico-radiological study was conducted involving 20 paediatric patients diagnosed as suffering from ICL between 1985 and 2003 at three hospitals in the Valencian Community.
Results:
70% of the cases were females and the average age when ICL was diagnosed was 5.3 years (interval from 2 months to 13 years). The most common initial clinical justification for the neuroradiological study was psychomotor retardation in eight patients (40%) and persistent, predominantly migrainous, headaches in six of them (30%). Only one patient was examined because of epilepsy. The prevailing site was the interhemispheric fissure in 10 patients (50%), followed by the quadrigeminal cistern in five (25%) and the mamillary body infundibulum axis in three of them (15%). One case was located in the cerebellum and another was found in the lateral ventricle, with involvement of the choroid fissure. Associated anomalies were observed in eight patients (40%). Alterations were seen in the development of the corpus callosum in six patients (30%), five in an isolated way and in one case there was partial absence of the associated septum pellucidum. Another patient was found to have an isolated partial agenesis of the septum and Goldenhar syndrome was detected in another case. The radiological follow up, which varied according to the initial clinical features, did not show any differences in the morphology or the size of the lipoma.
Conclusions:
1) ICL are more frequently located in the interhemispheric fissure and in the quadrigeminal cistern; 2) In these locations they can be associated with other brain malformations, the most important being defects in the callosa and septa; 3) Most ICL were found incidentally during the course of a neuroimaging examination. Only in the case of three patients (15%) was there any presumed relation between the location of the ICL (pericallosal), the symptomatology (overall psychomotor retardation) and the associated malformation (hypoplasia of the corpus callosum); 4) The incidence of epilepsy was much lower than that claimed in earlier reports, and the predominant associated neurological symptomatology was found to be psychomotor retardation and headache (70%); 5) ICL is a developmental anomaly that does not require neurosurgical treatment and which does not usually change with the passage of time, although it is liable to increase because of adipose hypertrophy.
