The Microsurgical Management of Benign Pineal Cysts: Helsinki Experience in 60 Cases

Overview

Journal Surg Neurol Int

Specialty Neurology

Date 2019 Sep 19

PMID 31528441

Citations 6

Authors

Joham Choque-Velasquez

Julio C Resendiz-Nieves

Behnam Rezai Jahromi

Roberto Colasanti

Rahul Raj

Kenneth Lopez-Gutierrez

Olli Tynninen

Mika Niemela

Juha Hernesniemi

Affiliations

Soon will be listed here.

Abstract

Background: Microsurgical resection represents a well-accepted management option for symptomatic benign pineal cysts. Symptoms such as a headache, hydrocephalus, and visual deficiency are typically associated with pineal cysts. However, more recent studies reported over the past years have characterized additional symptoms as a part of the clinical manifestation of this disease and represent additional indications for intervention.

Methods: We present a retrospective review of patients with histologically confirmed benign pineal cysts that were operated on in our department between 1997 and 2015. A demographic analysis, evaluation of preoperative status, surgical treatment, as well as immediate and long-term clinical and radiological outcomes were conducted.

Results: A total of 60 patients with benign pineal cysts underwent surgery between 1997 and 2015. Gross total resection was achieved in 58 cases. All patients except one improved in their clinical status or had made a full recovery at the time of the last follow-up. The key steps for surgical resection of pineal cysts are reported, based on an analysis of representative surgical videos.

Conclusions: We describe in this paper one of the largest series of microsurgically treated pineal cysts. In our opinion, judicious microsurgery remains the most suitable technique to effectively deal with this disease.

Citing Articles

Paediatric pineal region cysts: enigma or impaired neurofluid system?.

Ludwig H, Dreha-Kulaczewski S, Bock H Childs Nerv Syst. 2023; 39(12):3457-3466.

PMID: 37261536 PMC: 10684616. DOI: 10.1007/s00381-023-06000-4.

Incidental pineal gland cyst in girls with early onset of puberty.

DE Filippo G, Gaudino R, Calcaterra V, Villani A, Bozzola E, Bozzola M Ital J Pediatr. 2022; 48(1):44.

PMID: 35313951 PMC: 8935686. DOI: 10.1186/s13052-022-01235-4.

Surgical treatment of symptomatic pineal cysts without hydrocephalus-meta-analysis of the published literature.

Masina R, Ansaripour A, Benes V, Berhouma M, Choque-Velasquez J, Eide P Acta Neurochir (Wien). 2021; 164(1):61-77.

PMID: 34854993 PMC: 8761144. DOI: 10.1007/s00701-021-05054-0.

Management of pineal and colloid cysts.

Jenkinson M, Mills S, Mallucci C, Santarius T Pract Neurol. 2021; .

PMID: 34039752 PMC: 8327315. DOI: 10.1136/practneurol-2020-002838.

Functional status of surgically treated pineal cyst patients.

Choque-Velasquez J, Resendiz-Nieves J, Baluszek S, Colasanti R, Muhammad S, Hernesniemi J Surg Neurol Int. 2020; 11:359.

PMID: 33194292 PMC: 7656030. DOI: 10.25259/SNI_41_2020.

References

Engel U, Gottschalk S, Niehaus L, Lehmann R, May C, Vogel S . Cystic lesions of the pineal region--MRI and pathology. Neuroradiology. 2000; 42(6):399-402. DOI: 10.1007/s002340000308. View

Barboriak D, Lee L, Provenzale J . Serial MR imaging of pineal cysts: implications for natural history and follow-up. AJR Am J Roentgenol. 2001; 176(3):737-43. DOI: 10.2214/ajr.176.3.1760737. View

Michielsen G, Benoit Y, Baert E, Meire F, Caemaert J . Symptomatic pineal cysts: clinical manifestations and management. Acta Neurochir (Wien). 2002; 144(3):233-42; discussion 242. DOI: 10.1007/s007010200031. View

Sugiyama K, Arita K, Okamura T, Yamasaki F, Kajiwara Y, Ueda H . Detection of a pineoblastoma with large central cyst in a young child. Childs Nerv Syst. 2002; 18(3-4):157-60. DOI: 10.1007/s00381-002-0569-0. View

Griffith H . Technique of fontanelle and persutural ventriculoscopy and endoscopic ventricular surgery in infants. Childs Brain. 1975; 1(6):359-63. DOI: 10.1159/000119587. View

Gore P, Gonzalez L, Rekate H, Nakaji P . Endoscopic supracerebellar infratentorial approach for pineal cyst resection: technical case report. Neurosurgery. 2008; 62(3 Suppl 1):108-9. DOI: 10.1227/01.neu.0000317380.60938.79. View

Hernesniemi J, Romani R, Albayrak B, Lehto H, Dashti R, Ramsey 3rd C . Microsurgical management of pineal region lesions: personal experience with 119 patients. Surg Neurol. 2008; 70(6):576-83. DOI: 10.1016/j.surneu.2008.07.019. View

Cauley K, Linnell G, Braff S, Filippi C . Serial follow-up MRI of indeterminate cystic lesions of the pineal region: experience at a rural tertiary care referral center. AJR Am J Roentgenol. 2009; 193(2):533-7. DOI: 10.2214/AJR.08.1906. View

Husain N, Kumari M, Husain M . Tumor irrigation fluid enhances diagnostic efficacy in endoscopic biopsies of intracranial space-occupying lesions. Acta Neurochir (Wien). 2009; 152(1):111-7. DOI: 10.1007/s00701-009-0541-9. View

10.

Fetell M, Bruce J, Burke A, Cross D, Torres R, Powers J . Non-neoplastic pineal cysts. Neurology. 1991; 41(7):1034-40. DOI: 10.1212/wnl.41.7.1034. View

11.

Al-Holou W, Terman S, Kilburg C, Garton H, Muraszko K, Chandler W . Prevalence and natural history of pineal cysts in adults. J Neurosurg. 2011; 115(6):1106-14. DOI: 10.3171/2011.6.JNS11506. View

12.

Uschold T, Abla A, Fusco D, Bristol R, Nakaji P . Supracerebellar infratentorial endoscopically controlled resection of pineal lesions: case series and operative technique. J Neurosurg Pediatr. 2011; 8(6):554-64. DOI: 10.3171/2011.8.PEDS1157. View

13.

Hajnsek S, Paladino J, Petelin Gadze Z, Nankovic S, Mrak G, Lupret V . Clinical and neurophysiological changes in patients with pineal region expansions. Coll Antropol. 2013; 37(1):35-40. View

14.

Berhouma M, Ni H, Delabar V, Tahhan N, Memou Salem S, Mottolese C . Update on the management of pineal cysts: Case series and a review of the literature. Neurochirurgie. 2014; 61(2-3):201-7. DOI: 10.1016/j.neuchi.2013.08.010. View

15.

de Jong M, Moll A, Goricke S, van der Valk P, Kors W, Castelijns J . From a Suspicious Cystic Pineal Gland to Pineoblastoma in a Patient with Familial Unilateral Retinoblastoma. Ophthalmic Genet. 2014; 37(1):116-8. DOI: 10.3109/13816810.2014.929717. View

16.

Thaher F, Kurucz P, Fuellbier L, Bittl M, Hopf N . Endoscopic surgery for tumors of the pineal region via a paramedian infratentorial supracerebellar keyhole approach (PISKA). Neurosurg Rev. 2014; 37(4):677-84. DOI: 10.1007/s10143-014-0567-1. View

17.

Rados M, Oreskovic D, Rados M, Jurjevic I, Klarica M . Long lasting near-obstruction stenosis of mesencephalic aqueduct without development of hydrocephalus--case report. Croat Med J. 2014; 55(4):394-8. PMC: 4157388. DOI: 10.3325/cmj.2014.55.394. View

18.

Kalani M, Wilson D, Koechlin N, Abuhusain H, Dlouhy B, Gunawardena M . Pineal cyst resection in the absence of ventriculomegaly or Parinaud's syndrome: clinical outcomes and implications for patient selection. J Neurosurg. 2015; 123(2):352-6. DOI: 10.3171/2014.9.JNS141081. View

19.

Eide P, Ringstad G . Increased pulsatile intracranial pressure in patients with symptomatic pineal cysts and magnetic resonance imaging biomarkers indicative of central venous hypertension. J Neurol Sci. 2016; 367:247-55. DOI: 10.1016/j.jns.2016.06.028. View

20.

Starke R, Cappuzzo J, Erickson N, Sherman J . Pineal cysts and other pineal region malignancies: determining factors predictive of hydrocephalus and malignancy. J Neurosurg. 2016; 127(2):249-254. DOI: 10.3171/2016.8.JNS16220. View