A rare case report quadrigeminal plate cistern lipoma – an in-depth analysis of intracranial pathology and a literature review

Introduction: Intracranial lipomas are rare, benign congenital anomalies, comprising less than 0.1% of primary brain tumors. Among them, quadrigeminal plate cistern lipomas are the second most common subtype and are typically discovered incidentally due to their asymptomatic nature. Case description: We present the case of a 63-year-old male who reported diplopia, dizziness, and recurrent headaches over 6 weeks. Imaging revealed a 1 cm lipoma in the quadrigeminal plate cistern involving the origin of the left sixth cranial nerve. Conservative management with prism lenses provided symptomatic relief. Over 1 year of follow-up, the lesion remained radiologically stable. Persistent symptoms were attributed to coexisting subcortical white matter disease rather than progression of the lipoma. Discussion: Quadrigeminal cistern lipomas, while often asymptomatic, may cause neurological symptoms when in close proximity to cranial nerves or vascular structures. Complete surgical excision is typically avoided due to the high risk of neurovascular injury. Imaging characteristics on CT and MRI are essential for diagnosis, with fat-density and non-enhancing features being diagnostic hallmarks. The lesion in our case was managed non-surgically, aligning with current best practices. Conclusion: Quadrigeminal plate cistern lipomas are rare and generally benign, but may present with nonspecific symptoms mimicking more serious pathology. Accurate diagnosis through imaging and symptom correlation is key, with conservative management being the preferred approach in stable, non-progressive cases.