A case of hemorrhagic pineal cyst: MR/CT correlation

Osborn, Robin E.; Deen, H. Gordon; Kerber, CW; Glass, Renee

doi:10.1007/bf00698853

Cited by 42 publications

(18 citation statements)

References 8 publications

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“…Rarely, pineal cysts have been associated with gaze palsy or Parinaud syndrome. 11,17,29,36,39,40,46,47,67,69 We did not have any patients with either of these clinical manifestations in our series. The frequent association of other, likely incidental, symptoms with pineal cysts will make the clinical interpretation of any symptoms challenging.…”

Section: Discussionmentioning

confidence: 92%

Prevalence and natural history of pineal cysts in adults

Al-Holou¹,

Terman²,

Kilburg³

et al. 2011

JNS

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Object We reviewed our experience with pineal cysts to define the natural history and clinical relevance of this common intracranial finding. Methods The study population consisted of 48,417 consecutive patients who underwent brain MR imaging at a single institution over a 12-year interval and who were over 18 years of age at the time of imaging. Patient characteristics, including demographic data and other intracranial diagnoses, were collected from cases involving patients with a pineal cyst. We then identified all patients with pineal cysts who had been clinically evaluated at our institution and who had at least 6 months of clinical and imaging follow-up. All inclusion criteria for the natural history analysis were met in 151 patients. Results Pineal cysts measuring 5 mm or larger in greatest dimension were found in 478 patients (1.0%). Of these, 162 patients were male and 316 were female. On follow-up MR imaging of 151 patients with pineal cyst at a mean interval of 3.4 years from the initial study, 124 pineal cysts remained stable, 4 increased in size, and 23 decreased in size. Cysts that were larger at the time of initial diagnosis were more likely to decrease in size over the follow-up interval (p = 0.004). Patient sex, patient age at diagnosis, and the presence of septations within the cyst were not significantly associated with cyst change on follow-up. Conclusions Follow-up imaging and neurosurgical evaluation are not mandatory for adults with asymptomatic pineal cysts.

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Section: Discussionmentioning

confidence: 92%

Prevalence and natural history of pineal cysts in adults

Al-Holou¹,

Terman²,

Kilburg³

et al. 2011

JNS

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“…5 Over the subsequent years, sporadic reports of large symptomatic pineal cysts causing headache, Parinaud's syndrome, long tract signs, and pineal apoplexy appeared in the literature. 10,11,17,19,20,25 Although rare cases of pineal cysts continued to be reported, in nearly all cases the determination of "symptomatic" relied on signs of ventriculomegaly or Parinaud's syndrome. Klein and Rubinstein reported that among a surgical series of 7 symptomatic pineal cysts ranging in size from 1.0 to 4.5 cm, 5 patients demonstrated improvement following surgery.…”

Section: Discussionmentioning

confidence: 99%

“…3 Other sporadic reports suggest that a pineal cyst may cause intermittent obstruction of the sylvian aqueduct or compression of critical neural structures, making resection a reasonable option. 7,13,15,[17][18][19][20][21]25,26 Noncommunicating hydrocephalus and Parinaud's syndrome are rarely caused by a simple pineal cyst. Therefore, the benefit of surgery in the absence of intracranial hypertension is unclear.…”

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confidence: 99%

Pineal cyst resection in the absence of ventriculomegaly or Parinaud's syndrome: clinical outcomes and implications for patient selection

Kalani

Wilson

Koechlin

et al. 2015

JNS

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OBJECT Surgical indications for patients with pineal cysts are controversial. While the majority of patients harboring a pineal cyst require no treatment, surgery is a well-accepted option for a subset of those patients with secondary hydrocephalus or Parinaud's syndrome. The majority of pineal cysts are identified incidentally during workup for other potential conditions, which may or may not be related to the presence of the cyst. In the absence of clear obstruction of CSF pathways, the treatment of presumed symptomatic pineal cysts is debatable. To clarify the role of surgery in these borderline cases, the authors reviewed their experience with resection of pineal cysts in the absence of ventriculomegaly or Parinaud's syndrome. METHODS The authors retrospectively reviewed medical records and imaging of all patients surgically treated between 2001 and 2014 with a pineal cyst in the absence of ventriculomegaly and Parinaud's syndrome. The presenting symptoms, preoperative cyst size, preoperative radiographic aqueductal compression, extent of resection, and radiographic and clinical follow-up were documented. RESULTS Eighteen patients (14 female and 4 male; mean age 24 years, range 4–47 years) underwent cyst resection in the absence of ventriculomegaly or Parinaud's syndrome. Presenting symptoms included headache (17 patients), visual disturbances (10 patients), gait instability (5 patients), dizziness (5 patients), episodic loss of consciousness (2 patients), and hypersomnolence (1 patient). The mean preoperative cyst diameter was 1.5 cm (range 0.9–2.2 cm). All patients had a complete resection. At a mean clinical follow-up of 19.1 months (range postoperative to 71 months), 17 (94%) patients had resolution or improvement of their presenting symptoms. CONCLUSIONS The authors' results suggest that ventriculomegaly and Parinaud's syndrome are not absolute requisites for a pineal cyst to be symptomatic. Analogous to colloid cysts of the third ventricle, intermittent occlusion of cerebrospinal fluid pathways may cause small pineal cysts to become intermittently symptomatic. A select cohort of patients with pineal cysts may benefit from surgery despite a lack of hydrocephalus or other obvious compressive pathology.

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“…With regard to the possible natural history/growth of pineal cysts, previously published reports that spanned periods of 3 months to 4 years did not show visible enlargement as determined by MR imaging [Tamaki et al, 19891. On the other hand, the potential for spontaneous rupture and collapse of pineal cysts was reported in two cases in one of these studies [Tamaki et al, 19891. Only occasionally do pineal cysts cause signs or symptoms. According to published reports, these clinical manifestations may include headache, diplopia, Parinaud's sign, nausea, vomiting, papilledema, dysarthria, and visual disturbances [Osborn et al, 1989;Musolino et al, 1993;Stern and Ross, 19931. However, by far the majority of pineal cysts cause no signs or symptoms and are believed to be incidental to any presenting clinical syndrome.…”

Section: Discussionmentioning

confidence: 99%

“…As an aid in differentiating these other lesions from benign pineal cysts on the basis of MR imaging, dermoid cysts often contain a component of hyperintense fat, epidermoid lesions are usually larger and insinuate extensively into the surrounding cisterns, teratomas are often large and complex in their make-up with fat content and/or regions of solid enhancement after gadolinium administration, arachnoid cysts frequently exert a greater relative degree of mass effect and do not have an enhancing rim, and cysticercotic cysts on high resolution imaging often contain a visible mural scolex while at the same time showing other cysticercotic lesions elsewhere in the cranium. In addition, many of these latter pathologic processes are greater in size overall than most pineal cysts, have larger solid tissue component(s) and frequently present with obstructive hydrocephalus [Muller-Forell et al, 1988;Tamaki et al, 1989;Osborn et al, 1989;Tien et al, 1990;Zee et al, 199 11. Finally, pineal cell tumors do not usually undergo cystic degeneration at the relatively small size usually encountered in benign pineal cysts; and when tumoral cysts are present the ratio of solid tissue to cyst in neoplasia is typically greater [Muller-Forell et al, 1988;Tien et al, 1990;Zee et al, 19911. Calcifications are very common in the pineal gland, reaching an incidence as high at 84% as de-termined by histological investigation [Wildi and Frauchiger, 18651.…”

Section: Discussionmentioning

confidence: 99%

The midline pineal “eye”: MR and CT characteristics of the pineal gland with and without benign cyst formation

Jinkins

Xiong

Reíter

1995

Journal of Pineal Research

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The purpose of this study was to evaluate the magnetic resonance imaging characteristics of pineal cysts and pineal calcifications and to determine the incidence of benign pineal cysts. Two-hundred-fifty magnetic resonance examinations were retrospectively examined for the incidence of pineal cysts. In addition, 60 collected cases of pineal cysts were evaluated with regard to cross sectional diameter and magnetic resonance signal characteristics. Finally, the magnetic resonance signal characteristics of pineal tissue in 50 patients were compared to companion computed tomographic scans that were scrutinized for the presence or absence of calcification. The incidence of pineal cysts as revealed by magnetic resonance imaging in this study was 10.8%. The minimal and maximal measurements ranged from a low of 2 x 2 x 2 mm to a high of 10 x 12 x 10 mm. The magnetic resonance signal intensities of pineal cyst as compared to cerebrospinal fluid were iso- or hyperintense on all magnetic resonance sequences in the majority of cases. Calcifications of the pineal gland as revealed by computed tomography tended to be isointense to gray matter if the calcifications were small and hypointense to gray matter if large on all magnetic resonance acquisitions. A careful analysis of the magnetic resonance signal characteristics enables the recognition of moderate- to large-sized pineal calcifications and their differentiation from large pineal cysts. However, small cysts of the pineal gland can be difficult or impossible to distinguish on magnetic resonance imaging from calcifications without comparison with computed tomography.

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A case of hemorrhagic pineal cyst: MR/CT correlation

Cited by 42 publications

References 8 publications

Prevalence and natural history of pineal cysts in adults

Prevalence and natural history of pineal cysts in adults

Pineal cyst resection in the absence of ventriculomegaly or Parinaud's syndrome: clinical outcomes and implications for patient selection

The midline pineal “eye”: MR and CT characteristics of the pineal gland with and without benign cyst formation

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