Delayed Lateral Rectus Palsy Following Resection of a Pineal Cyst in Sitting Position: Direct or Indirect Compressive Phenomenon?

Stevens, Qualls E.; Colen, Chaim B.; Ham, Steven D.; Kattner, Keith A.; Sood, Sandeep

doi:10.1177/0883073807307094

Cited by 18 publications

(16 citation statements)

References 15 publications

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“…In a surgical series of 11 patients with pineal cysts, Fetell et al 19 found that patients with headaches can be expected to have postoperative symptomatic relief only if the headaches were caused by hydrocephalus. Although there are reports of surgical treatment of pineal cysts for the treatment of chronic headaches, 20,23,29,62 we do not regard a history of chronic headache in the absence of hydrocephalus as an indication for surgical treatment of a pineal cyst at our institution.…”

Section: Discussionmentioning

confidence: 99%

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: 99%

Prevalence and natural history of pineal cysts in adults

Al-Holou¹,

Terman²,

Kilburg³

et al. 2011

JNS

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“…Stevens et al reported a 13-year-old girl who developed unilateral lateral rectus palsy postoperatively following resection of a pineal cyst in the sitting position [4]. Interestingly, her symptoms of an isolated sixth nerve palsy developed four days after surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Intracranial air along the course of a cranial nerve can result in isolated cranial nerve palsy from direct compression. A review of the literature revealed only three reports of isolated, single cranial nerve deficits due to pneumocephalus [2–4]. …”

Section: Introductionmentioning

confidence: 99%

Delayed Pneumocephalus-Induced Cranial Neuropathy

Marupudi

Mittal

2013

Case Reports in Medicine

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Pneumocephalus is a common occurrence after cranial surgery, with patients typically remaining asymptomatic from a moderate amount of intracranial air. Postsurgical pneumocephalus rarely causes focal neurological deficits; furthermore, cranial neuropathy from postsurgical pneumocephalus is exceedingly uncommon. Only 3 cases have been previously reported that describe direct cranial nerve compression from intracranial air resulting in an isolated single cranial nerve deficit. The authors present a patient who developed dysconjugate eye movements from bilateral oculomotor nerve palsy. Direct cranial nerve compression occurred as a result of postoperative pneumocephalus in the interpeduncular cistern. The isolated cranial neuropathy gradually recovered as the intracranial air was reabsorbed.

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“…Although there are reports of pineal cyst surgery performed for the treatment of chronic headaches, 119,122,126,127 most surgeons do not regard a history of chronic headache in the absence of hydrocephalus as an indication for surgical treatment of a pineal cyst. Not surprisingly, headaches can be expected to have reliable postoperative symptomatic relief only if the headaches were caused by hydrocephalus.…”

Section: Pineal Cystsmentioning

confidence: 99%

Incidental Findings on Brain and Spine Imaging in Children

Maher¹,

Piatt²,

Ragheb³

et al. 2015

Pediatrics

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In recent years, the utilization of diagnostic imaging of the brain and spine in children has increased dramatically, leading to a corresponding increase in the detection of incidental findings of the central nervous system. Patients with unexpected findings on imaging are often referred for subspecialty evaluation. Even with rational use of diagnostic imaging and subspecialty consultation, the diagnostic process will always generate unexpected findings that must be explained and managed. Familiarity with the most common findings that are discovered incidentally on diagnostic imaging of the brain and spine will assist the pediatrician in providing counseling to families and in making recommendations in conjunction with a neurosurgeon, when needed, regarding additional treatments and prognosis.

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Delayed Lateral Rectus Palsy Following Resection of a Pineal Cyst in Sitting Position: Direct or Indirect Compressive Phenomenon?

Cited by 18 publications

References 15 publications

Prevalence and natural history of pineal cysts in adults

Prevalence and natural history of pineal cysts in adults

Delayed Pneumocephalus-Induced Cranial Neuropathy

Incidental Findings on Brain and Spine Imaging in Children

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