Background: Microsurgical resection represents a well-accepted management option for symptomatic benign pineal cysts. Symptoms such as a headache, hydrocephalus, and visual deficiency are typically associated with pineal cysts. However, more recent studies reported over the past years have characterized additional symptoms as a part of the clinical manifestation of this disease and represent additional indications for intervention. Methods: We present a retrospective review of patients with histologically confirmed benign pineal cysts that were operated on in our department between 1997 and 2015. A demographic analysis, evaluation of preoperative status, surgical treatment, as well as immediate and long-term clinical and radiological outcomes were conducted. Results: A total of 60 patients with benign pineal cysts underwent surgery between 1997 and 2015. Gross total resection was achieved in 58 cases. All patients except one improved in their clinical status or had made a full recovery at the time of the last follow-up. The key steps for surgical resection of pineal cysts are reported, based on an analysis of representative surgical videos. Conclusions: We describe in this paper one of the largest series of microsurgically treated pineal cysts. In our opinion, judicious microsurgery remains the most suitable technique to effectively deal with this disease.

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A protocolized praying position that includes proper teamwork management may provide a simple, fast, and safe approach for proper placement of the patient for pineal region surgery.

Background: Pineal region tumors represent challenging surgical lesions with wide ranges of survival rates reported in different surgical series. Here, we emphasize the role of the complete microsurgical resection (CMR) in order to obtain a favorable long-term outcome of pineal region tumors. Methods:We report a retrospective study of pineal region tumors operated in Helsinki Neurosurgery between 1997 and 2015. Information was obtained from the hospital records, and an evaluation of the Finnish population register was conducted in July 2018 to determine the current status of the patients.Results; 76 pineal region tumors were operated. The survival rate was 62 % at a mean follow up of 125±105 (0-588) months, and the disease-related mortality was limited to 14 (18.4%) patients. Up to July 2018, twenty-nine patients had died. 2 patients died 1 and 3 months after surgery with delayed thalamic infarctions, 12 patients with disease progression, and 15 had non disease-related deaths. Only one patient was lost in the long-term FU. 10/14 disease-related deaths occurred during the first 5 years of follow up: 5 diffuse gliomas, 3 germ cell tumors, 1 Grade II-III PPTID, and 1 meningioma. CMR was linked to better tumor free survival and long-term survival rates with exception of diffuse gliomas. Conclusion:CMR, in the setting of a multidisciplinary management of pineal region tumors, correlates with favorable survival rates and with minimal mortality. Surgically treated grade II-IV gliomas conform a particular group with high mortality within the first 5 years independently of the microsurgical resection.