Skip to main content

Advertisement

SpringerLink
Log in

Clinical management of pineal cysts: a worldwide online survey

  • Clinical Article - Brain Tumors
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Background

A pineal cyst is a benign affection of a pineal gland on the borderline between a pathological lesion and a variant of normality. Clinical management of patients with a pineal cyst remains controversial, especially when patients present with non-specific symptoms.

Methods

An online questionnaire consisting of 13 questions was completed by 110 neurosurgeons worldwide. Responses were entered into a database and subsequently analysed.

Results

Based on data from the questionnaire, the main indication criteria for pineal cyst resection are hydrocephalus (90 % of the respondents), Parinaud’s syndrome (80 %) and growth of the cyst (68 %). Only 15 % of the respondents occasionally operate on patients with non-specific symptoms. If surgery is indicated, improvement is expected in 88 % of the patients. The vast majority of the respondents favour a supracerebellar infratentorial approach to the pineal region. Most (78 %) of the respondents regarded the patient registry as a potentially useful instrument.

Conclusions

This survey sheds light on the current practice of pineal cyst management across the world. Most of the respondents perform surgery on pineal cysts only if patients are presenting with symptoms attributable to a mass effect. Surgery for patients with non-specific complaints (headache, vertigo) is not widely accepted, although it may prove effective. A prospective patient registry might be useful in the decision-making process in the clinical management of pineal cysts.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Golzarian J, Balériaux D, Bank WO, Matos C, Flament-Durand J (1993) Pineal cyst: normal or pathological? Neuroradiology 35:251–253

    Article  CAS  PubMed  Google Scholar 

  2. Menovsky T, De Ridder D, Grotenhuis JA (2011) Non-specific symptoms related to pineal cysts. Minim Invasive Neurosurg 54:50

    Article  CAS  PubMed  Google Scholar 

  3. Al-Holou WN, Terman SW, Kilburg C, Garton HJ, Muraszko KM, Chandler WF, Ibrahim M, Maher CO (2011) Prevalence and natural history of pineal cysts in adults. J Neurosurg 115:1106–1114

    Article  PubMed  Google Scholar 

  4. Sawamura Y, Ikeda J, Ozawa M, Minoshima Y, Saito H, Abe H (1995) Magnetic resonance images reveal a high incidence of asymptomatic pineal cysts in young women. Neurosurgery 37:11–16

    Article  CAS  PubMed  Google Scholar 

  5. Al-Holou WN, Maher CO, Muraszko KM, Garton HJ (2010) The natural history of pineal cysts in children and young adults. J Neurosurg Pediatr 5:162–166

    Article  PubMed  Google Scholar 

  6. Barboriak DP, Lee L, Provenzale JM (2001) Serial MR imaging of pineal cysts: implications for natural history and follow-up. AJR Am J Roentgenol 176:737–743

    Article  CAS  PubMed  Google Scholar 

  7. Berhouma M, Ni H, Delabar V, Tahhan N, Memou Salem S, Mottolese C, Vallee B (2015) Update on the management of pineal cysts: case series and a review of the literature. Neurochirurgie 61:201–207

    Article  CAS  PubMed  Google Scholar 

  8. Fetell MR, Bruce JN, Burke AM, Cross DT, Torres RA, Powers JM, Stein BM (1991) Non-neoplastic pineal cysts. Neurology 41:1034–1040

    Article  CAS  PubMed  Google Scholar 

  9. Seifert CL, Woeller A, Valet M, Zimmer C, Berthele A, Tölle T, Sprenger T (2008) Headaches and pineal cyst: a case–control study. Headache 48:448–452

    Article  PubMed  Google Scholar 

  10. Fain JS, Tomlinson FH, Scheithauer BW, Parisi JE, Fletcher GP, Kelly PJ, Miller GM (1994) Symptomatic glial cysts of the pineal gland. J Neurosurg 80:454–460

    Article  CAS  PubMed  Google Scholar 

  11. Hajnsek S, Paladino J, Gadze ZP, Nanković S, Mrak G, Lupret V (2013) Clinical and neurophysiological changes in patients with pineal region expansions. Coll Antropol 37:35–40

    PubMed  Google Scholar 

  12. Krause F (1911) Chirurgie des Gehirns und Rückenmarks. Urban and Schwazenberg, Berlin

    Google Scholar 

  13. Kalani MY, Wilson DA, Koechlin NO, Abuhusain HJ, Dlouhy BJ, Gunawardena MP, Nozue-Okada K, Teo C (2015) Pineal cyst resection in the absence of ventriculomegaly or Parinaud’s syndrome: clinical outcomes and implications for patient selection. J Neurosurg 123:352–356

    Article  PubMed  Google Scholar 

  14. Peres MF, Zukerman E, Porto PP, Brandt RA (2004) Headaches and pineal cyst: a (more than) coincidental relationship? Headache 44:929–930

    Article  PubMed  Google Scholar 

  15. Fleege MA, Miller GM, Fletcher GP, Fain JS, Scheithauer BW (1994) Benign glial cysts of the pineal gland: unusual imaging characteristics with histologic correlation. AJNR Am J Neuroradiol 15:161–166

    CAS  PubMed  Google Scholar 

  16. Davies JM, Ozpinar A, Lawton MT (2015) Volume-outcome relationships in neurosurgery. Neurosurg Clin N Am 26:207–218

    Article  PubMed  Google Scholar 

  17. Jakola AS, Bartek J Jr, Mathiesen T (2013) Venous complications in supracerebellar infratentorial approach. Acta Neurochir (Wein) 155:477–478

    Article  Google Scholar 

  18. Tirakotai W, Schulte DM, Bauer BL, Bertalanffy H, Hellwig D (2004) Neuroendoscopic surgery of intracranial cysts in adults. Childs Nerv Syst 20:842–851

    Article  PubMed  Google Scholar 

  19. Behrens P, Ostertag CB (1993) Stereotaktisches Vorgehen bei Pinealiszysten. Fortschr Neurol Psychiatr 61:284–289

    Article  CAS  PubMed  Google Scholar 

  20. Kreth FW, Schätz CR, Pagenstecher A, Faist M, Volk B, Ostertag CB (1996) Stereotactic management of lesions of the pineal region. Neurosurgery 39:280–289

    Article  CAS  PubMed  Google Scholar 

  21. Musolino A, Cambria S, Rizzo G, Cambria M (1993) Symptomatic cysts of the pineal gland: stereotactic diagnosis and treatment of two cases and review of the literature. Neurosurgery 32:315–320

    Article  CAS  PubMed  Google Scholar 

  22. Stern JD, Ross DA (1993) Stereotactic management of benign pineal region cysts: report of two cases. Neurosurgery 32:310–314

    Article  CAS  PubMed  Google Scholar 

  23. Wiso JH, Epstein F (1992) Surgical management of symptomatic pineal cysts. J Neurosurg 77:896–900

    Article  Google Scholar 

  24. Michielsen G, Benoit Y, Baert E, Meire F, Caemaert J (2002) Symptomatic pineal cysts: clinical manifestations and management. Acta Neurochir (Wein) 144:233–42

    Article  CAS  Google Scholar 

  25. Sajko T, Kudelić N, Lupret V, Lupret V Jr, Nola IA (2009) Treatment of pineal region lesions: our experience in 39 patients. Coll Antropol 33:1259–1563

    PubMed  Google Scholar 

  26. Di Chirico A, Di Rocco F, Velardi F (2001) Spontaneous regression of a symptomatic pineal cyst after endoscopic third-ventriculostomy. Childs Nerv Syst 17:42–46

    Article  PubMed  Google Scholar 

  27. Spears RC (2004) Colloid cyst headache. Curr Pain Headache Rep 8:297–300

    Article  PubMed  Google Scholar 

  28. Gross RE, Watts RL, Hauser RA, Bakay RA, Reichmann H, von Kummer R, Ondo WG, Reissig E, Eisner W, Steiner-Schulze H, Siedentop H, Fichte K, Hong W, Cornfeldt M, Beebe K, Sandbrink R, Spheramine Investigational Group (2011) Intrastriatal transplantation of microcarrier-bound human retinal pigment epithelial cells versus sham surgery in patients with advanced Parkinson’s disease: a double-blind, randomised, controlled trial. Lancet Neurol 10:509–519

    Article  PubMed  Google Scholar 

  29. Kallmes DF, Comstock BA, Heagerty PJ, Turner JA, Wilson DJ, Diamond TH, Edwards R, Gray LA, Stout L, Owen S, Hollingworth W, Ghdoke B, Annesley-Williams DJ, Ralston SH, Jarvik JG (2009) A randomized trial of vertebroplasty for osteoporotic spinal fractures. N Engl J Med 361:569–579

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Funding

The Ministry of Defence of the Czech Republic provided financial support in the form of grant funding (grant no.: MO 1012NK). The sponsor had no role in the design or conduct of this research.

Author information

Authors and Affiliations

  1. Department of Neurosurgery of 1st Faculty of Medicine of Charles University, Military University Hospital Prague, U Vojenske nemocnice 1200, Prague, Czech Republic

    Martin Májovský, David Netuka & Vladimír Beneš

Authors
  1. Martin Májovský
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. David Netuka
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Vladimír Beneš
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Martin Májovský.

Ethics declarations

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organisation or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study by submitting the online questionnaire.

Appendix 1

Appendix 1

1. Where do you come from?

2. How many years of clinical practice do you have?

(a) 0–10 years

(b) 10–20 years

(c) 20–30 years

(d) 30 years and more

3. Your department is:

(a) an academic institution

(b) a non-academic institution

4. Do you consider a pineal cyst as a surgical lesion?

(a) yes

(b) no

5. In your opinion, which of the following symptoms is a legitimate indication for pineal cyst resection?

(a) headache

(b) vertigo

(c) diplopia

(d) endocrinological disturbances

(e) obstructive hydrocephalus

(f) Parinaud’s syndrome

(g) growth of the cyst

(h) clinician’s “gut feeling“

(i) other

6. How many patients with a pineal cyst do you see per year in your department (newly diagnosed)?

(a) none

(b) 1–2

(c) 3–5

(d) 6–10

(e) 11–20

(f) more than 20

7. Do you sometimes indicate surgery in patients with a pineal cyst that present with non-specific complaints (i.e. headache, sleep disturbances)?

(a) yes

(b) no

8. Do you follow-up adult patients with asymptomatic pineal cysts?

(a) yes, periodical MR scan and clinical examination

(b) yes, periodical clinical examination only

(c) no

9. Approximately, how many patients with a pineal cyst do you operate on in your department per year?

(a) none

(b) 1–2

(c) 3–5

(d) more than 5

10. What surgical approach do you prefer in accessing a pineal cyst?

(a) microscopic supracerebellar infratentorial

(b) endoscopic supracerebellar infratentorial

(c) occipital transtentorial

(d) microscopic transcallosal interforniceal

(e) endoscopic transventricular

(f) stereotactic aspiration

11. Based on your experience, what are the results from pineal cyst surgery?

(a) nearly all the patients improve

(b) the majority of the patients improve

(c) approximately half of the patients improve

(d) only a minority of the patients improve

12. Do you think an international registry of patients with a pineal cyst could be useful?

(a) yes

(b) no

13. Would you like to make a comment?

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Májovský, M., Netuka, D. & Beneš, V. Clinical management of pineal cysts: a worldwide online survey. Acta Neurochir 158, 663–669 (2016). https://doi.org/10.1007/s00701-016-2726-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00701-016-2726-3

Keywords

Search

Navigation