Symptomatic Pineal Cyst: Case Report and Review of the Literature

Costa, Francesco; Fornari, Maurizio; Valla, P.; Servello, Domenico

doi:10.1055/s-2008-1073171

Cited by 22 publications

(10 citation statements)

References 5 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: 89%

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: 89%

Prevalence and natural history of pineal cysts in adults

Al-Holou¹,

Terman²,

Kilburg³

et al. 2011

JNS

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“…[1][2][3]6,8,22 In rare cases, large cysts may obstruct the cerebral aqueduct, causing ventriculomegaly or compress the tectum, causing Parinaud's syndrome. 7,10,11,15,18,26 In our practice we have treated 3 patients who presented with hydrocephalus caused by compression of the aqueduct by a pineal cyst. While these findings are well-accepted indications for surgery, the majority of patients with pineal cysts do not present with these signs, and indications for intervention in these patients is unclear.…”

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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“…Despite several authors recommending this technique, the major drawback is the need for 2 bur holes and 2 separate transcortical passes. 3,6,13,14,25,27 A third technique is to perform 1 bur hole but use a flexible endoscope. 2,[8][9][10]20,23 The flexible endoscope may be flexed anteriorly and posteriorly to reach the tuber cinereum or the tumor site and is used to perform both the ETV and the EBX.…”

Section: Discussionmentioning

confidence: 99%

“…1A); 15,[20][21][22]26 2) performing 2 separate bur holes: one in an "ideal" location for an ETV and the second more anteriorly in an "ideal" location for a biopsy (Fig. 1B); 3,6,13,14,25,27 and 3) using a flexible endoscope through a single bur hole. 2,[8][9][10]20,23 The limitations of these options are a compromise for both the ETV and for the EBX when using a single bur hole and rigid endoscope, the need for 2 entry points and trajectories in the second option, and compromised visual quality and technical limitations using only a flexible endoscope.…”

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confidence: 99%

Combined rigid and flexible endoscopy for tumors in the posterior third ventricle

Roth

Constantini

2015

JNS

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T umors leading to occlusion of the sylvian aqueduct include those of pineal, thalamic, and tectal origins. These tumors frequently cause obstructive hydrocephalus and thus necessitate a CSF diversion procedure, such as an endoscopic third ventriculostomy (ETV).The histopathological differential diagnosis of tumors leading to aqueductal occlusion includes germ cell tumors, ependymomas, and astrocytomas. As the treatment paradigm may change according to pathology (and grade), a tumor biopsy is often indicated. Thus, in many cases a dual procedure is recommended: an ETV combined with an endoscopic biopsy (EBX). 17The trajectory for an ETV is pointed more anteriorly than the optimal trajectory for an EBX of a posterior third ventricular tumor. 17 The foramen of Monro limits the trajectory both anteriorly (avoiding injury to the fornix) and posteriorly (avoiding injury to the venous angle and genu of the internal capsule). Various techniques have been suggested to combine an ETV with an EBX, including 1) performing 1 bur hole, between both ideal entry points and using a rigid endoscope (Fig. 1A); 15,[20][21][22]26 2) performing 2 separate bur holes: one in an "ideal" location for an ETV and the second more anteriorly in an "ideal" location for a biopsy (Fig. 1B); 3,6,13,14,25,27 and 3) using a flexible endoscope through a single bur hole. 2,[8][9][10]20,23 The limitations of these options are a compromise for both the ETV and for the EBX when using a single bur hole and rigid endoscope, the need for 2 entry points and trajectories in the second option, and compromised visual quality and technical limitations using only a flexible endoscope. To overcome abbreviatioNs EBX = endoscopic biopsy; ETV = endoscopic third ventriculostomy; IVH = intraventricular hemorrhage. obJect Tumors leading to occlusion of the sylvian aqueduct include those of pineal, thalamic, and tectal origins. These tumors cause obstructive hydrocephalus and thus necessitate a CSF diversion procedure such as an endoscopic third ventriculostomy (ETV), often coupled with an endoscopic biopsy (EBX). Lesions located posterior to the massa intermedia pose a technical challenge, as the use of a rigid endoscope for performing both an ETV and EBX is limited. The authors describe their experience using a combined rigid and flexible endoscopic procedure through a single bur hole for both procedures in patients with posterior third ventricular tumors. methods Since January 2012, patients with posterior third ventricular tumors causing hydrocephalus underwent dual ETV and EBX procedures using the combined rigid-flexible endoscopic technique. Following institutional review board approval, data from clinical, radiological, surgical, and pathological records were retrospectively collected. results Six patients 3.5-53 years of age were included. Lesion locations included pineal (n = 3), fourth ventricle (n = 1), aqueduct (n = 1), and tectum (n = 1). The ETV and EBX were successful in all cases. Pathologies included pilocytic astrocytoma, pineoblastoma, ependymoma G...

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Symptomatic Pineal Cyst: Case Report and Review of the Literature

Cited by 22 publications

References 5 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

Combined rigid and flexible endoscopy for tumors in the posterior third ventricle

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