Quadrigeminal cistern lipoma

Last revised by Mostafa Elfeky on 20 Jul 2023

Quadrigeminal cistern lipomas make up approximately 25% of intracranial lipomas and are located within the quadrigeminal cistern. They may be associated with hypoplasia of the inferior colliculus or agenesis of the corpus callosum.

For a general discussion please refer to the article on intracranial lipomas.

They are usually asymptomatic and are usually found incidentally. Rarely do they cause mass effect resulting in seizures or hydrocephalus 7. Due to their location, If symptomatic, patients usually present with diplopia, disturbances in behavior due to brainstem compression and signs of hydrocephalus 9.

CT and MRI findings are characteristic for a fat-containing mass or lesion, however located in the quadrigeminal cistern. 

CT demonstrates a lobulated, non-enhancing fat attenuating (often (HU = − 50 to − 100) mass in the quadrigeminal cistern. Peripheral calcification can be present in some cases. 

MRI reveals signal characteristic of fat:

  • T1: high signal intensity

  • T2: high signal intensity 

  • T1 C+ (Gd): no enhancement

  • fat saturated sequences: low signal intensity

  • SWI: can produce blooming due to susceptibility artifact 8

Lipomas, in general, are mostly asymptomatic. Asymptomatic lesions often do not require treatment. If there is mass effect causing seizures or hydrocephalus, then surgical management can be considered 4,6,7. Endoscopic approach is a less invasive surgical option as it limits exposure and cerebellar retraction 9.

Differentials specific to its location (quadrigeminal plate) include tectal plate glioma or mass, tectal plate cyst, arachnoid cyst, dermoid cyst and epidermoid cyst 7.

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