Abstract

Background: Lipoma of Sylvian fissure is a rare lesion. When seizure is intractable surgical excision is indicated. Here we are presenting a case of Sylvian fissure lipoma and the surgical difficulties encountered along with the review of literature.

Case Description: Refractory seizure in a 28 year old male was evaluated. Head computed tomography revealed hypodense lesion of fat attenuation in right Sylvian fissure. On magnetic resonance imaging lesion was hyperintense on both T1 and T2 weighted images with complete suppression on T1 weighted fat suppressed image. Radiological impression was that of lipoma. Standard right pterional craniotomy was performed. Lesion was seen in the Sylvian fissure splaying the inferior frontal gyrus and superior temporal gyrus. Major vessels were seen traversing the lesion. With meticulous dissection near total excision of the lesion was done. Frozen and final histopathological examination was confirmative of lipoma. There was minimal residual lesion seen as calcification on imaging. Post operatively patient was followed up for 6 months with decrease in seizure frequency without any deficit.

Conclusion: Our case report and literature supports the fact that the surgical excision of Sylvian fissure lipoma is extremely difficult and no attempt should be made for complete excision of the lesion. Even now in the era of microsurgery, Sylvian fissure should always be dealt cautiously.

Keywords: Lipoma; Seizure; Sylvian Fissure; Tumor; Intracranial Benign Lesions; Epilepsy; Microneurosurgery

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