Child's Nervous System

, Volume 19, Issue 10–11, pp 750–755 | Cite as

Pineal cysts in childhood

  • Marek ManderaEmail author
  • Wieslaw Marcol
  • Grażyna Bierzyńska-Macyszyn
  • Ewa Kluczewska
Original Paper



Little is known about the incidence and symptomatology of pineal cysts in children. Until now, the proper management of this group of patients has not been established.


The purpose of this study was to evaluate the epidemiological and clinical features of pineal cysts in children and adolescents and to try to find guidelines for their management.

Methods and results

We analyzed 24 patients (17 girls, mean age 9, and 7 boys, mean age 14) with pineal cysts found as the only pathology on MRI. Six patients were treated surgically (excision of the cysts via a supracerebellar-infratentorial approach) because of the progression of neurological symptoms or the enlargement of the cyst at follow-up. In this group of patients, no surgery-related complications were noted, nor was residual cyst observed on postoperative MRI. In 4 cases, histological examination revealed simple cysts, but in 2 cases pineocytomas were diagnosed. Preoperative symptoms disappeared except light headache in 2 cases and in 1 case no improvement was obtained. The remaining 18 patients had a mean follow-up of 38 months (range 24–60 months). None of the cysts diminished or collapsed. We also measured the circadian pattern of melatonin secretion as well as β-HCG and AFP levels in serum before surgery. We found very high night levels of melatonin in both of the patients with pineocytomas, while the patients with pineal cysts showed normal or depressed melatonin secretion profile.


We concluded that though most pineal cysts were clinically benign they should be followed up for many years. If the cyst grows larger in follow-up MRI study and neurological symptoms are progressive, surgical treatment should be performed. In the authors' opinion, one of the markers discriminating benign and neoplastic lesions may be melatonin.


Pineal cysts Children Surgery Melatonin Management 


  1. 1.
    Commentz JC, Helmke K (1995) Precocious puberty and decreased melatonin secretion due a hypothalamic hamartoma. Horm Res 44:271–275PubMedGoogle Scholar
  2. 2.
    Copper ERA (1944) Cystic hydrops of the pineal gland. J Nerv Ment Dis 99:552–572Google Scholar
  3. 3.
    Dempsey RJ, Chandler WF (1984) Abnormal serum melatonin levels in patients with intrasellar tumors. Neurosurgery 15:815–819PubMedGoogle Scholar
  4. 4.
    Engel U, Gottschalk S, Niehaus L, Lehmann R, May C, Vogel S, Janisch W (2000) Cystic lesions of the pineal region—MRI and pathology. Neuroradiology 42:399–402PubMedGoogle Scholar
  5. 5.
    Fain JS, Tomlinson FH, Scheithauer BW, Parisi JE, Fletcher GP, Kelly PJ, Miller GM (1994) Symptomatic glial cysts of the pineal gland. J Neurosurg 80:454–460PubMedGoogle Scholar
  6. 6.
    Fetell MR, Bruce JN, Burke AM, Cross DT, Torres RAA, Powers JM, Stein BM (1991) Non-neoplastic pineal cysts. Neurology 41:1034–1040PubMedGoogle Scholar
  7. 7.
    Fleege A, Miller GM, Fletcher GP, Fain JS, Scheithauer BW (1994) Benign glial cysts of the pineal gland: unusual imaging characteristic with histologic correlation. Am J Neuroradiol 15:161–167PubMedGoogle Scholar
  8. 8.
    Fukui M, Natori Y, Matsushima T, Nishio S, Ikezaki K (1998) Operative approaches to the pineal region tumors. Childs Nerv Syst 14:49–52CrossRefPubMedGoogle Scholar
  9. 9.
    Hasegava A, Ohtsubo F, Mori W (1987) Pineal gland in old age; quantitative and qualitative morphological study of 168 human autopsy cases. Brain Res 33:113–11CrossRefGoogle Scholar
  10. 10.
    Hirato J, Nakazato Y (2001) Pathology of pineal region tumors. J Neurooncology 54:239–249Google Scholar
  11. 11.
    Jinkins JR, Xiong L, Reiter RJ (1995) The midline pineal "eye": MR and CT characteristic of the pineal gland with and without benign cyst formation. J Pineal Res 19:64–71PubMedGoogle Scholar
  12. 12.
    Kang HS, Kim DG, Han DH (1998) Large glial cyst of the pineal gland: a possible growth mechanism. Case report. J Neurosurg 88:138–140PubMedGoogle Scholar
  13. 13.
    Kitayama J, Toyoda K, Fujii K, Ibayashi S, Sugimori H, Sadoshima S, Fujishima M (1996) Recurrent aseptic meningitis caused by rupture of a pineal cyst. No To Shinkei 48:1147–1150PubMedGoogle Scholar
  14. 14.
    Kjos BO, Brant-Zawadzki M, Kucharczyk W, Kelly WM, Norm D, Newton TH (1985) Cystic intracranial lesions: MR imaging. Radiology 155:363–369PubMedGoogle Scholar
  15. 15.
    Kluczewska E, Lorenz-Giec A, Bażowski P, Mandera M, Baron J, Zieliński Z (1999) Analiza i symtomatologia torbieli szyszynki w badaniach rezonansu magnetycznego. Neurol Neurochir Pol 33:1033–1043PubMedGoogle Scholar
  16. 16.
    Lewis DW, Ashwal S, Dahl G, Dorbad D, Hirtz D, Prensky A, Jarjour I (2002) Practice parameter: evaluation of children and adolescent with recurrent headaches. Neurology 59:490–499PubMedGoogle Scholar
  17. 17.
    Michielsen G, Benoit Y, Baert E, Meire F, Caemaert J (2002) Symptomatic pineal cysts: clinical manifestation and management. Acta Neurochir (Wien) 144:233–242Google Scholar
  18. 18.
    Milroy CM, Smith CL (1996) Sudden death due to a glial cyst of the pineal gland. J Clin Pathol 49:267–269PubMedGoogle Scholar
  19. 19.
    Momozaki N, Ikezaki K, Abe M, Fukui M, Fujii K, Kishikawa T (1992) Cystic pineocytoma—case report. Neurol Med Chir (Tokyo) 32:169–171Google Scholar
  20. 20.
    Mukherjee KK, Banerji D, Sharma R (1999) Pineal cyst presenting with intracystic and subarachnoid haemorrhage: report of a case and review of the literature. Br J Neurosurg 13:189–192CrossRefPubMedGoogle Scholar
  21. 21.
    Neatherlin JS (1985) Pineal region brain tumors. J Neurosurg Nurs 17:349–354PubMedGoogle Scholar
  22. 22.
    Neuwelt EA, Lewy AJ (1983) Disappearance of plasma melatonin after removal of a neoplastic pineal gland. N Engl J Med 308:1132–1135PubMedGoogle Scholar
  23. 23.
    Russel DS, Rubinstein LJ (1977) Non-neoplastic cyst. In: Pathology of tumours of the nervous system. Arnold, London, p 295Google Scholar
  24. 24.
    Sawamura Y, Ikeda J, Ozawa M, Minoshima Y, Saito H, Abe H (1995) Magnetic resonances images reveal a high incidence of asymptomatic pineal cysts in young women. Neurosurgery 37:11–15PubMedGoogle Scholar
  25. 25.
    Schmidt F, Penka B, Trauner M, Reinsperger L, Ranner G, Ebner F, Waldhauser F (1995) Lack of pineal growth during childhood. J Clin Endocrinol Metab 80:1221–1223PubMedGoogle Scholar
  26. 26.
    Sener RN (1995) The pineal gland: a comparative MR imaging study in children and adults with respect to normal anatomical variations and pineal cysts. Pediatr Radiol 25:245–248PubMedGoogle Scholar
  27. 27.
    Steven DA, McGinn GJ, McClarty BM (1996) A choroid plexus papilloma arising from an incidental pineal cyst. Am J Neuroradiol 17:939–942PubMedGoogle Scholar
  28. 28.
    Sugiyama K, Arita K, Okamura T, Yamasaki F, Kajiwara Y, Ueda H, Kurisu K (2002) Detection of a pineoblastoma with large central cyst in young child. Childs Nerv Syst 18:157–160CrossRefPubMedGoogle Scholar
  29. 29.
    Tamaki N, Shirataki K, Lin T, Masumura M, Katayama S, Matsumoto S (1989) Cysts of the pineal gland. A new clinical entity to be distinguished from tumors of the pineal region. Childs Nerv Syst 5:172–176PubMedGoogle Scholar
  30. 30.
    Tapp E (1979) The histology and pathology of the human pineal gland. In: Kappers JA, Pevet P (eds) The pineal gland of vertebrates including MA. Elsevier/North-Holland, Amsterdam, pp 481–500Google Scholar
  31. 31.
    Vaquero J, Martinez R, Escandon J, Bravo G (1988) Symptomatic glial cysts of the pineal gland. Surg Neurol 30:468–470PubMedGoogle Scholar
  32. 32.
    Vorkapic P, Waldhauser F, Bruckner R, Biegelmayer C, Schmidbauer M, Pendl G (1987) Serum melatonin level: a new neurodiagnostic tool in pineal region tumors? Neurosurgery 21:817–824PubMedGoogle Scholar
  33. 33.
    Wisoff JH, Epstein F (1992) Surgical management of symptomatic pineal cysts. J Neurosurg 77:896–900PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2003

Authors and Affiliations

  • Marek Mandera
    • 1
    Email author
  • Wieslaw Marcol
    • 1
  • Grażyna Bierzyńska-Macyszyn
    • 2
  • Ewa Kluczewska
    • 3
  1. 1.Division of Pediatric Neurosurgery, Department of Pediatric SurgerySilesian University School of MedicineKatowicePoland
  2. 2.Department of PathomorphologySilesian University School of MedicineKatowicePoland
  3. 3.Division of Diagnostic Imaging, Department of RadiologySilesian University School of MedicineKatowicePoland

Personalised recommendations