Lipomas of the pineal region

Background: Intracranial lipomas are rare lesion,representing 0.02% of operated intracranial lesions. Lipomas of the pineal region are even rarer and are reported occasionally in the literture. This is possibly because of the fact that they may give rise to clinical symmptoms rather infrequently. When they become symptomatic, some form of management must be contemplated. METHODS: Fouro cases of lipomas of the pineal region observed in our institute durin 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.RESULT: Computed tomography(CT) scanning was performed in 3 cases and magnetic resonance imaging (MRI) in all 4. MRI angiography was perfomed in the last case. The appeareance of the lipoma was quite pathognomic 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 in one case and supracerebellar route in another. Neither approach appeared to be superior to the other one. Total removal of the lesion. CONCLUSION: Lipomas of the pineal region are rare. Modern neuroimmaging permits a straightforwards diagnosis of the nature of intracranial lipomas in general and of the lipomas in particular. Some form of management must be contemplated when these lwsions become symptomatic. Direct surgical approach, either via an occipital transtentorial or aninfratentorial supracerebellar approach, is feasible. Tumor removal must be dealt with cautionaly because total removal is impossible without unacceptable postoperative deficits, and generous partial removal warrants long-term symptomatic improvement.