Two patients with Sylvian fissure lipoma are reported. One of them was oper
ate on because of an increased frequency of epileptic seizures in spite of
high dose carbamazepine treatment. A review of the literature regarding the
surgical experience with Sylvian lipomas revealed only four cases, and in
none of them was the lipoma removed totally. One of ours is the first case
in which total removal of the lipoma was achieved. The postoperative course
was uneventful and carbamazepine dose was gradually lowered without furthe
r epileptic activity. If these exceedingly rare lesions cause symptoms then
surgical intervention is indicated. With microsurgical techniques, Sylvian
fissure lipomas can be removed totally without complication and symptomati
c improvement may result.