A 65-year-old male presented with a rare lipoma in the quadrigeminal cistern manifesting as left abducens nerve paresis which was effectively treated by total extirpation. The usual neurological symptoms of lipoma in the quadrigeminal cistern are intracranial hypertension and hydrocephalus which can be successfully treated by shunt operation. Direct surgery is indicated when the symptoms are ascribed to localized symptoms, but tumor removal should be partial if the superior cerebellar arteries are involved.