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20220401(桥小脑角脂肪瘤) Cerebellopontine angle lipoma
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Cerebellopontine angle lipoma Among cerebellopontine angle (CPA) lesions, lipomas represent a rare entity estimated at 0.1%. They are thought to arise from fatty differentiation of primitive meningeal cells rather than a neoplastic growth mechanism. While CPA lipomas display indolent growth potential, they can involve cranial nerve fibers, most commonly the vestibulocochlear nerve. Accordingly, the most common presenting symptom is hearing loss (62%), followed by dizziness (43%) and tinnitus (42%). They can be relatively easily identified on CT as a homogeneous fat density lesion. On MRI, the lipid nature of CPA lipomas can be identified with fat-suppression techniques. On non-fat-suppressed MRI, CPA lipomas show T1 hyperintensity, T2 hyperintensity (on fast-spin-echo sequences), lack of enhancement, and lack of diffusion restriction. Due to its location and involvement of the cranial nerves, the preferred management for a CPA lipoma is conservative. Partial resection can be performed in the setting of intractable symptoms, but neurologic symptoms improve only in approximately 50% of patients, and new postoperative neurologic deficits can occur in 70% of patients. Total resection is not performed in general due to the intricate association of CPA lipomas with the adjacent cranial nerves, brainstem, and vasculature. Radiation is not indicated due to the potential to induce fibrosis in the area. References Bonneville F, Sarrazin JL, Marsot-Dupuch K, et al. Unusual lesions of the cerebellopontine angle: A segmental approach. Radiographics. 2001;21(2):419-438. Brodsky JR, Smith TW, Litofsky S, Lee DJ. Lipoma of the cerebellopontine angle. Am J Otolaryngol. 2006;27(4):271-274. Bertot B, Steele WJ, Boghani Z, Britz G. Diagnostic dilemma: Cerebellopontine angle lipoma versus dermoid cyst. Cureus. 2017;9(11):e1894. Tankéré F, Vitte E, . Cerebellopontine angle lipomas: Report of four cases and review of the literature. Neurosurgery. 2002;50(3):626-632.
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