1/25/2024 0 Comments Incidental pineal cystThere is agreement that surgical intervention should be undertaken in patients presenting with hydrocephalus, progression of neurologic symptoms, or cyst enlargement. Symptomatic cysts vary in size from 7 mm to 45 mm, whereas asymptomatic cysts are usually less than 10 mm in diameter, although a relationship between the cyst size and the onset of symptoms has been proved to be irrelevant in many cases. Less frequently, patients present with ataxia, motor and sensory impairment, mental and emotional disturbances, epilepsy, circadian rhythm disturbances, hypothalamic dysfunction of precocious puberty, and recently described occurrence of secondary parkinsonism. The most common symptoms include headache, vertigo, visual and oculomotor disturbances, and obstructive hydrocephalus. Pineal cysts usually have no clinical implications and remain asymptomatic for years. A recent study demonstrated the findings obtained by transcranial sonography to correspond to those obtained by MRI in the detection of both pineal gland cyst and pineal gland itself, and could be used in the future mainly as follow up examination. The diagnosis of pineal cyst is usually established by MRI with defined radiological criteria to distinguish benign pineal cyst from tumors of this area. In series of magnetic resonance imaging (MRI) studies, the prevalence of pineal cysts ranged between 1.3% and 4.3% of patients examined for various neurologic reasons and up to 10.8% of asymptomatic healthy volunteers. Published by Elsevier Masson SAS.Pineal cysts occur in all ages, predominantly in adults in the fourth decade of life. In the majority of incidental pineal cysts, a clinical and imaging follow-up is sufficient but occasionally not required especially in adults as very rare cases of increase in size have been reported.ĭiagnostic and operative techniques Diagnostic et techniques opératoires Endoscopie Endoscopy Glande pinéale Histoire naturelle IRM Kyste pinéal MRI Natural history Pineal cyst Pineal gland.Ĭopyright © 2014. In the two non-operated patients, the cyst remained stable and no recurrences were observed in all operated patients with a mean follow-up of 144 months. Overall, peri-operative mortality was nil. Four patients required a preoperative ventriculo-peritoneal shunt due to life-threatening obstructive hydrocephalus. Twenty patients were operated via a suboccipital transtentorial approach with total removal of the cyst in 70% of the cases, while the remaining 4 cases were treated with an intraventricular endoscopic marsupialization associating a third ventriculostomy. Two adult cases presented with non-specific headaches and did not require surgery. Symptoms included intracranial hypertension with obstructive hydrocephalus in 18 cases and oculomotor anomalies in 12 cases. The mean age was 23.5 years ranging from 7 to 49 years. Twenty-six patients with pineal cysts were identified. A systematic review of the literature is also presented. Their medical records were retrospectively assessed focusing on the initial symptoms, imaging characteristics of the cyst, management strategy, operative technique and their complications, as well as the latest follow-up. Symptomatic pineal cysts may require a surgical solution but therapeutic indications have not yet been clearly established.įrom 1986 to 2012, 26 patients with pineal cysts were identified. Incidental pineal cysts have become more common which raises the question of their management. The natural history of pineal cysts still remains unclear.
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