Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jun 1;24(6):572-581.
doi: 10.1227/ons.0000000000000620. Epub 2023 Jan 19.

Defining Occult High-Risk Cysts of the Pineal Region: A Case Series

Sergio W Guadix  1 , Neelan J Marianayagam  1 , Elizabeth K Weidman  2 , Melissa Yuan  3 , Benjamin Liechty  4 , Jeffrey P Greenfield  1 , Mark M Souweidane  1
Affiliations

Defining Occult High-Risk Cysts of the Pineal Region: A Case Series

Sergio W Guadix et al. Oper Neurosurg. .

Abstract

Background: Absence of hydrocephalus on neuroimaging may impart a false sense of security for patients with pineal cysts. In this case series, we characterize a subset of patients with pineal cysts having an occult presentation. Unifying features of worsening paroxysmal headaches suggesting intermittent obstructive hydrocephalus and radiographic evidence of third ventricular invagination characterize these patients as high risk.

Objective: To define features of occult, high-risk pineal cysts and outcomes of endoscopic cyst fenestration.

Methods: Charts were retrospectively reviewed for patients with pineal cysts evaluated at our institution between 2018 and 2021 who underwent endoscopic cyst fenestration. To capture cysts presenting as occult, patients were excluded if hydrocephalus was noted at presentation. Relevant clinical history, imaging, operative data, and clinical outcomes were reviewed.

Results: Of 50 pineal cyst patients, 4 satisfied inclusion criteria. All patients presented with worsening paroxysmal headaches. In addition, 75% (3/4) also experienced intermittent syncope. Patients exhibited no hydrocephalus (n = 3) or fluctuating ventricular size on longitudinal imaging (n = 1). In all cases, high-resolution sagittal 3-dimensional T2 magnetic resonance imaging demonstrated invagination of the cyst anteriorly into the posterior third ventricle. All patients underwent endoscopic cyst fenestration with complete symptom resolution (mean follow-up of 20.6 months; range 3.5-37.4 months).

Conclusion: The clinical history for occult, high-risk pineal cysts is notable for worsening paroxysmal headaches and episodic alterations of consciousness suggesting intermittent obstructive hydrocephalus. Because ventricular size can appear normal on standard imaging protocols, clinical suspicion should trigger workup with high-resolution magnetic resonance imaging designed to detect these cysts. Endoscopic cyst fenestration is a safe and efficacious management strategy.

PubMed Disclaimer

Comment in

References

    1. Nevins EJ, Das K, Bhojak M, et al. Incidental pineal cysts: is surveillance necessary? World Neurosurg. 2016;90:96-102.
    1. Al-Holou WN, Terman SW, Kilburg C, et al. Prevalence and natural history of pineal cysts in adults: clinical article. J Neurosurg. 2011;115(6):1106-1114.
    1. Al-Holou WN, Garton HJL, Muraszko KM, Ibrahim M, Maher CO. Prevalence of pineal cysts in children and young adults. J Neurosurg Pediatr. 2009;4(3):230-236.
    1. Choque-Velasquez J, Resendiz-Nieves J, Colasanti R, Hernesniemi J. Management of obstructive hydrocephalus associated with pineal region cysts and tumors and its implication in long-term outcome. World Neurosurg. 2021;149:e913-e923.
    1. Berhouma M, Ni H, Delabar V, et al. Update on the management of pineal cysts: case series and a review of the literature. Neurochirurgie. 2015;61(2-3):201-207.

MeSH terms

LinkOut - more resources