Endoscopic Treatment of a Symptomatic Pineal Cyst

Turtz, Alan; Hughes, W. Brian; Goldman, Howard

doi:10.1227/00006123-199511000-00025

Cited by 35 publications

(10 citation statements)

References 16 publications

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“…The first craniotomy for a pineal cyst was performed in 1914, and since that time less than one hundred cases have been reported. 1,[3][4][5][6]13,[17][18][19][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] The majority of these cases represent cysts that presented with mass effect on the dorsal midbrain leading to visual complaints or symptoms secondary to obstruction of cerebrospinal fluid pathways.…”

Section: Discussionmentioning

confidence: 99%

Pineal Apoplexy: Is it a Facilitator for the Development of Pineal Cysts?

McNeely

Howes

Mehta

2003

Can. j. neurol. sci.

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Background:The radiographic identification of pineal cysts has increased dramatically within the last two decades due to the advent of magnetic resonance imaging. Pineal cysts are often found incidentally with only a minority of these lesions ever becoming symptomatic and requiring treatment. Many theories attempting to explain the pathogenesis of these cysts exist.Methods:We describe a case of a 12-year-old girl who presents with a pineal hemorrhage of unknown etiology with associated hydrocephalus.Results:Her hydrocephalus was initially treated with an external ventricular drain followed by a third ventriculostomy. She had no evidence of elevated beta human chorionic gonadotropin or alpha-fetoprotein within the serum or cerebrospinal fluid. Follow-up imaging at seven weeks revealed resolution of her hemorrhage, however, there was development of a progressive cystic lesion within the pineal region. In order to make a definitive tissue diagnosis, a supracerebellar infratentorial surgical approach with complete resection was performed. During the resection, brownish fluid was aspirated from the cyst and the cyst wall was removed. The pathological diagnosis was a pineal cyst.Conclusions:Although cases have been described of pineal apoplexy with an underlying cyst, this case describes the development of a progressive pineal cyst secondary to a hemorrhage. This case demonstrates that pineal hemorrhage may be a promotor for the development or progression of pineal cysts.

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Section: Discussionmentioning

confidence: 99%

Pineal Apoplexy: Is it a Facilitator for the Development of Pineal Cysts?

McNeely

Howes

Mehta

2003

Can. j. neurol. sci.

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“…Since the publication of Ferrer et al in 1997, 13 third ventriculostomy has been shown to be of great use for the obtainment of biopsies of tumors in the pineal region and for the resolution of hydrocephalus. Although the Ferrer et al study describes the taking of biopsies in adult patients with a flexible endoscope, the usefulness of this procedure performed with a rigid endoscope has been established by Robinson and Cohen, 3 who described the procedure in four pediatric patients using an access route that implies making an incision more anterior to the coronal suture (5 cm) to gain access to the third ventricle, perform third ventriculostomy for treatment of hydrocephalus, and take a biopsy of the tumor in the posterior portion of the third ventricle.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Approach for the Treatment of Pineal Region Tumors

Herrada-Pineda

Revilla-Pacheco

Manrique-Guzman

2013

J Neurol Surg A Cent Eur Neurosurg

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Tumors of the pineal region account for 3 to 8% of the tumors involving the central nervous system. The most common are germ cell tumors (39%). Less common examples include teratomas, primitive neuroectodermic tumors, astrocytomas, and choriocarcinomas. Clinical presentation in pediatric patients is in direct relation to the anatomical structures surrounding the pineal region and to the associated hydrocephalus that is present in almost 90% of cases. The diagnosis of a tumor in the pineal region is based on radiological findings and the presence of tumor markers such as α-fetoprotein and human chorionic gonadotrophic hormone subfraction β. Neuroendoscopy is considered to be one of the minimally invasive techniques useful for the management of such patients. This minimally invasive approach to pineal region tumors allows the treatment of hydrocephalus in a safe and effective way, avoiding the complications derived from other procedures such as external ventricular drainage or shunt surgery.

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“…Endoscopic third ventriculostomy can be used to address many of these concerns. [1,2,4,11,13] Endoscopic third ventriculostomy is a definitive treatment for all types of noncommunicating hydrocephalus and has well established success rates. [8][9][10] Successful treatment is even more common in patients with acquired noncommunicating hydrocephalus such as the patients in this series (91%).…”

Section: Discussionmentioning

confidence: 99%

Endoscopic management of hydrocephalus secondary to tumors of the posterior third ventricle

Teo¹,

Young²

1999

FOC

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Management of the obstructive hydrocephalus that accompanies tumors located in the third ventricle has traditionally involved either urgent tumor resection, with resultant ventricular decompression, or cerebrospinal fluid diversion that requires either ventriculostomy or shunt placement prior to tumor removal. Although this approach has worked well for the better part of a century, it has both short- and long-term sequelae that can possibly be avoided. Beacause a number of lesions in this area are benign or are amenable to radiotherapy, a less invasive approach to their treatment is desirable. The advances in both instrumentation and techniques of endoscopic surgery have established alternatives to the traditional treatment of third ventricular tumors and resultant hydrocephalus. The authors review the treatment of 19 patients with posterior third ventricular tumors who presented to Arkansas Children's Hospital over a 5-year period (September 1993–July 1999). In 11 patients signs and/or symptoms of hydrocephalus were demonstrated and were treated with endoscopic third ventriculostomy, additionally, a biopsy procedure, resection, or fenestration of the tumor was performed in a number of patients. Endoscopy was believed to have been of benefit in all patients, despite the eventual failure of the ventriculostomy in one patient. There were no complications in this series. The algorithm thus developed by the authors provides both a diagnostic and therapeutic pathway that may ultimately reduce the morbidity associated with the treatment of patients with posterior third ventricular lesions.

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Endoscopic Treatment of a Symptomatic Pineal Cyst

Abstract: Symptomatic pineal cysts are rare and typically managed with an open surgical approach. We report the successful treatment of a symptomatic pineal cyst using a stereotactic endoscopic technique.

Cited by 35 publications

References 16 publications

Pineal Apoplexy: Is it a Facilitator for the Development of Pineal Cysts?

Pineal Apoplexy: Is it a Facilitator for the Development of Pineal Cysts?

Endoscopic Approach for the Treatment of Pineal Region Tumors

Endoscopic management of hydrocephalus secondary to tumors of the posterior third ventricle

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