case_images: PMC9840568_01
case_images: The Sylvian lipoma shows a markedly high signal intensity on axial T1-weighted imaging (A) and fluid-attenuated inversion recovery imaging (B), along with a slightly high signal intensity on axial T2-weighted imaging (C) on preoperative magnetic resonance imaging. The Sylvian lipoma shows signal supression on axial diffusion-weighted imaging (D) and the corresponding apparent diffusion coefficient map (E). The anterior temporal cortex adjacent to the Sylvian lipoma shows hypometabolism on fluorodeoxyglucose positron emission tomography/computed tomography (F)
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case_images: Fig1
case_images: Memory Scale-Revised (WMS-R) demonstrated no memory decline (verbal memory 94, visual memory 103, general memory 96, attention/concentration 105, delayed recall 96) before surgery. Magnetic resonance imaging (MRI) showed a mass lesion in the left Sylvian fissure with homogeneous hyperintensity on both T1-weighted and T2-weighted images but no diffusion restriction on diffusion-weighted images/apparent diffusion coefficient maps (Fig. 1).
case_images: Intraoperative electrocorticography using an epidural electrode as reference shows the high-amplitude spikes on the ventral side of the anterior temporal lobe
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case_images: Fig2
case_images: The ioECoG showed IEDs at the strip electrodes located on the anterior lateral temporal lobe (Fig. 2). Therefore, we performed the anterior temporal lobectomy (ATL) 3 cm from the temporal tip without removing the Sylvian lipoma (Fig. 3).
case_images: The intraoperative image after the anterior temporal lobectomy shows the remaining temporal lobe, hippocampus, and Sylvian lipoma covered with the pia mater of the Sylvian fissure
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case_images: Fig3
case_images: The ioECoG showed IEDs at the strip electrodes located on the anterior lateral temporal lobe (Fig. 2). Therefore, we performed the anterior temporal lobectomy (ATL) 3 cm from the temporal tip without removing the Sylvian lipoma (Fig. 3).
case_images: After the anterior temporal lobectomy, the Sylvian lipoma is shown isolated from the temporal lobe on axial diffusion-weighted (A), T2-weighted (B), and fluid-attenuated inversion recovery imaging (C)
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case_images: Fig4
case_images: Postoperative MRI demonstrated the preserved Sylvian lipoma and branches of the middle cerebral artery within the Sylvian fissure (Fig. 4).