Prevalence and natural history of pineal cysts in adults

Abstract

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.

A Hemorrhagic Pineal Cyst with a Bacterial Meningitis-like Manifestation and Benign Outcome

“…Asymptomatic enlargement has been identified in some pineal cysts (1). Several hypotheses, including growth due to intracystic microhemorrhage (2, 3, 5), have been proposed to explain the enlargement of pineal cysts.…”

“…The prevalence of pineal cysts in patients undergoing intracranial imaging has been estimated to range from 1.0 to 4.4% (1,7,8). The prevalence of pineal cysts has a female predominance and an age-related pattern, with the prevalence rising to a peak late in childhood or early in adulthood and then falling throughout the later age ranges (1,8).…”

“…Although the vast majority of pineal cysts, even large ones, can be expected to be found incidentally and remain asymptomatic (1), some patients may present with signs and symptoms of increased intracranial pressure or focal signs and symptoms due to compression and edema in neighboring structures (2, 3). Pineal apoplexy is generally considered to be rare (1,(4)(5)(6). Most patients with pineal apoplexy have been reported to have relatively severe symptoms that often accompany acute occlusive hydrocephalus (4-6) and may occasionally result in sudden death (11) or the need for surgical treatment.…”

“…Pineal cysts are a common incidental finding in imaging studies, especially since the advent of magnetic resonance (MR) imaging (1). Although the majority of these cysts are benign and are usually asymptomatic, some are occasionally associated with headaches, hydrocephalus, extraocular movement abnormalities and Parinaud's syndrome (2,3).…”

Incidental Findings on Brain and Spine Imaging in Children

“…[101][102][103][104][105][106] Pineal cyst prevalence changes with age, but these cysts are found more frequently in girls than in boys in all age groups. [101][102][103][105][106][107][108][109] They are relatively unusual in infants, becoming more common in childhood and adolescence, and peak in young adulthood when they are seen in as many as 2% to 4% of brain MRIs. They become increasingly uncommon with advancing age in adulthood.…”