Child's Nervous System

, Volume 29, Issue 5, pp 753–760 | Cite as

Pineal cysts in children: case-based update

  • Gokmen Kahilogullari
  • Luca MassimiEmail author
  • Concezio Di Rocco
Case-Based Update



Pineal cysts (PC) are found in children as often asymptomatic and without change in their size over the time. However, there are some debatable issues about their evolution and management in the pediatric population. The aim of the present paper is to update the information regarding pathogenesis, clinical presentation, and management of these lesions.


All the pertinent literature was reviewed, and a meta-analysis of operated on cases was carried out. An illustrative case regarding the clinical evolution of a 13-year-old girl is also presented.

Results and conclusions

PC are often asymptomatic and do not evolve over the time. However, since there is a certain risk of clinical and/or radiological progression, or even sudden and severe clinical onset (apoplexy), both a clinical and radiological follow-up is recommended in the pediatric age. The surgical excision is usually limited to symptomatic patients or to cases with clear radiological evolution.


Pineal cyst Pineal gland Management Surgery Children 


  1. 1.
    Alberti O, Riegel T, Hellwig D, Bertalanffy H (2001) Frameless navigation and endoscopy. J Neurosurg 95:541–543PubMedGoogle Scholar
  2. 2.
    Al-Holou WN, Garton HJ, Muraszko KM, Ibrahim M, Maher CO (2009) Prevalence of pineal cysts in children and young adults. J Neurosurg Pediatr 4:230–236PubMedCrossRefGoogle Scholar
  3. 3.
    Al-Holou WN, Maher CO, Muraszko KM, Garton HJ (2010) The natural history of pineal cysts in children and young adults. J Neurosurg Pediatr 5:162–166PubMedCrossRefGoogle Scholar
  4. 4.
    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 115:1106–1114PubMedCrossRefGoogle Scholar
  5. 5.
    Ayhan S, Bal E, Palaoglu S, Cila A (2011) Pineal cyst apoplexy: report of an unusual case managed conservatively. Neurol Neuchir Pol 45:604–607Google Scholar
  6. 6.
    Bosnjak J, Budisic M, Azman D, Strineka M, Crnjakovic M, Demarin V (2009) Pineal gland cyst—an overview. Acta Clin Croat 48:355–358PubMedGoogle Scholar
  7. 7.
    Brotchi J, Levivier M, Raftopoulos C, Dewitte O, Pirotte B, Noterman J (1991) Three-quarter prone to the pineal–tentorial region. Report of seven cases. Acta Neurochir Supp (Wien) 53:144–147CrossRefGoogle Scholar
  8. 8.
    Budisic M, Bosnjak J, Lovrencic-Huzjan A, Mikula I, Bedek D, Demarin V (2008) Pineal cyst evaluated by transcranial sonography. Eur J Neurol 15:229–233PubMedCrossRefGoogle Scholar
  9. 9.
    Cauley KA, Linnell GJ, Braff SP, Filippi CG (2009) Serial follow-up MRI of indeterminate cystic lesions of the pineal region: experience at a rural tertiary care referral center. AJR Am J Roentgenol 193:533–537PubMedCrossRefGoogle Scholar
  10. 10.
    Chernov MF, Kamikawa S, Yamane F, Ishihara S, Kubo O, Hori T (2006) Neurofiberscopic biopsy of tumors of the pineal gland region and posterior third ventricle: indications, technique, complications, and results. Neurosurgery 59:267–277PubMedCrossRefGoogle Scholar
  11. 11.
    Choy W, Kim W, Spasic M, Voth B, Yew A, Yang I (2011) Pineal cysts: a review of clinical and radiological features. Neurosurg Clin N Am 22:341–351PubMedCrossRefGoogle Scholar
  12. 12.
    Costa F, Fornari M, Valla P, Servello D (2008) Symptomatic pineal cyst: case report and review of the literature. Minim Invasive Neurosurg 51:231–233PubMedCrossRefGoogle Scholar
  13. 13.
    Day GA, McPhee IB, Tuffley J, Tomlinson F, Chaseling R, Kelle S, Torode I, Sherwood M, Cutbush K, Geddes AJ, Brankoff B (2007) Idiopathic scoliosis and pineal lesions in Australian children. J Orthop Surg (Hong Kong) 15:327–333Google Scholar
  14. 14.
    Dickermann RD, Stevens QE, Steide JA, Schneider SJ (2004) Precocious puberty associated with a pineal cyst: is it disinhibition of the hypothalamic–pituitary axis? Neuro Endocrinol Lett 25:173–175Google Scholar
  15. 15.
    Di Chirico A, Di Rocco F, Velardi F (2001) Spontaneous regression of a symptomatic pineal cyst after endoscopic third-ventriculostomy. Childs Nerv Syst 17:42–46PubMedCrossRefGoogle Scholar
  16. 16.
    Di Costanzo A, Tedeschi G, Di Salle F, Golia F, Morrone R, Bonavita V (1993) Pineal cysts: an incidental MRI finding? J Neurol Neurosurg Psychiatry 56:207–208PubMedCrossRefGoogle Scholar
  17. 17.
    Eskandary H, Sabba M, Khajehpour F, Eskandari M (2005) Incidental findings in brain computed tomography scans of 3000 head trauma patients. Surg Neurol 63:550–553PubMedCrossRefGoogle Scholar
  18. 18.
    Evans RW, Peres MF (2010) Headaches and pineal cysts. Headache 50:666–668PubMedCrossRefGoogle Scholar
  19. 19.
    Fain JS, Tomlinson FH, Scheithauer BW, Parisi JE, Fletcher GP, Kelly PJ, Miller GM (1994) Symptomatic glial cysts of the pineal gland. J Neurosurg 80:454–460PubMedCrossRefGoogle Scholar
  20. 20.
    Fakhran S, Escott EJ (2008) Pineocytoma mimicking a pineal cyst on imaging: true diagnostic dilemma or a case of incomplete imaging? AJNR Am J Neuroradiol 29:159–163PubMedCrossRefGoogle Scholar
  21. 21.
    Gaab MR, Schroeder HW (1999) Neuroendoscopic approach to intraventricular lesions. Neurosurg Focus 6:E5PubMedCrossRefGoogle Scholar
  22. 22.
    Gaillard F, Jones J (2010) Masses of the pineal region: clinical presentation and radiographic features. Postgrad Med J 86:597–607PubMedCrossRefGoogle Scholar
  23. 23.
    Gore PA, Gonzalez LF, Rekate HL, Nakaji P (2008) Endoscopic supracerebellar infratentorial approach for pineal cyst resection: technical case report. Neurosurgery 62:108–109PubMedCrossRefGoogle Scholar
  24. 24.
    Harrer JU, Klötzsch C, Oertel MF, Möller-Hartmann W (2005) Sonographic detection and follow up an atypical pineal cyst: a comparison with magnetic resonance imaging. J Neurosurg 103:564–566PubMedCrossRefGoogle Scholar
  25. 25.
    Hayashida Y, Hirai T, Korogi Y, Kochi M, Maruyama N, Yamura M, Yamashita Y (2004) Pineal cystic germinoma with syncytiotrophoblastic giant cells mimicking MR imaging findings of a pineal cyst. AJNR Am J Neuroradiol 25:1538–1540PubMedGoogle Scholar
  26. 26.
    Herrera EJ, Cáceres M, Viano JC, Costello G, Suarez MS, Suárez JC (1999) Stereotactic neurosurgery in children and adolescents. Childs Nerv Syst 15:256–260PubMedCrossRefGoogle Scholar
  27. 27.
    Hirato J, Nakazato Y (2001) Pathology of pineal region tumors. J Neuro-Oncol 54:239–249CrossRefGoogle Scholar
  28. 28.
    Jia W, Ma Z, Liu IY, Zhang Y, Jia G, Wan W (2011) Transcallosal interforniceal approach to pineal region tumors in 150 children. J Neurosurg Pediatr 7:98–103PubMedCrossRefGoogle Scholar
  29. 29.
    Kang HS, Kim DG, Han DH (1998) Large glial cyst of the pineal gland: a possible growth mechanism. Case report. J Neurosurg 88:138–140PubMedCrossRefGoogle Scholar
  30. 30.
    Karadaş O, Ipekdal IH, Ulaş UH, Odabaşi Z (2012) Nocturnal headache associated with melatonin deficiency due to a pineal gland cyst. J Clin Neurosci 19:330–332PubMedCrossRefGoogle Scholar
  31. 31.
    Karatza EC, Shields CL, Flanders AE, Gonzalez ME, Shields JA (2006) Pineal cyst simulating pinealoblastoma in 11 children with retinoblastoma. Arch Ophthalmol 124:595–597PubMedCrossRefGoogle Scholar
  32. 32.
    Klein P, Rubinstein LJ (1989) Benign symptomatic glial cysts of the pineal gland: a report of seven cases and review of the literature. J Neurol Neurosurg Psychiatry 52:991–995PubMedCrossRefGoogle Scholar
  33. 33.
    Kodera T, Bozinov O, Sürücü O, Ulrich NS, Burkhardt JK, Bertalanffy H (2011) Neurosurgical venous considerations for tumors of the pineal region resected using the infratentorial supracerebellar approach. J Clin Neurosci 18:1481–1485PubMedCrossRefGoogle Scholar
  34. 34.
    Koenigsberg RA, Faro S, Marino R, Turz A, Goldman W (1996) Imaging of pineal apoplexy. Clin Imaging 20:91–94PubMedCrossRefGoogle Scholar
  35. 35.
    Korogi Y, Takahashi M, Ushio Y (2001) MRI of pineal region tumors. J Neurooncol 54:251–261PubMedCrossRefGoogle Scholar
  36. 36.
    Kreth FW, Schätz CR, Pagenstecher A, Faist M, Volk B, Ostertag CB (1996) Stereotactic management of lesion of the pineal region. Neurosurgery 39:280–291PubMedCrossRefGoogle Scholar
  37. 37.
    Kumar KV, Verma A, Modi KD, Rayudu BR (2010) Precocious puberty and pineal cyst—an uncommon association. Indian Pediatr 17:193–194CrossRefGoogle Scholar
  38. 38.
    Lacroix-Boudhrioua V, Linglart A, Ancel PY, Falip C, Bougneres PF, Adamsbaum C (2011) Pineal cysts in children. Insights Imaging 2:671–678PubMedCrossRefGoogle Scholar
  39. 39.
    Laure-Kamionowska M, Maslinska D, Deregowski CE, Raczkowska B (2003) Morphology of pineal glands in human foetuses and infants with brain lesions. Folia Neuropathol 41:209–215PubMedGoogle Scholar
  40. 40.
    Leston J, Mottolese C, Champier J, Jouvet A, Brun J, Sindou M, Chazot G, Claustrat B, Fevre-Montange M (2009) Contribution of the daily melatonin profile to diagnosis of tumors of the pineal region. J Neurooncol 93:387–394PubMedCrossRefGoogle Scholar
  41. 41.
    Mandera M, Marcol W, Bierzynska-Macyszyn G, Kluczewska E (2003) Pineal cysts in childhood. Childs Nerv Syst 19:750–755PubMedCrossRefGoogle Scholar
  42. 42.
    Maurer PK, Ecklund J, Parisi JE, Ondra S (1990) Symptomatic pineal cyst: case report. Neurosurgery 27:451–454PubMedCrossRefGoogle Scholar
  43. 43.
    McNeely PD, Howes WJ, Mehta V (2003) Pineal apoplexy: is it a facilitator for the development of pineal cysts? Can J Neurol Sci 30:67–71PubMedGoogle Scholar
  44. 44.
    Mena H, Armonda RA, Ribas JL, Ondra SL, Rushing EJ (1997) Non-neoplastic pineal cysts: a clinicopathologic study of twenty-one cases. Ann Diagn Pathol 1:11–18PubMedCrossRefGoogle Scholar
  45. 45.
    Menovsky T, De Ridder D, Grotenhuis JA (2011) Non-specific symptoms related to pineal cysts. Minim Invas Neurosurg 54:50CrossRefGoogle Scholar
  46. 46.
    Michielsen G, Benoit Y, Baert E, Meire F, Caemaert J (2002) Symptomatic pineal cysts: clinical manifestations and management. Acta Neurochir (Wien) 144:233–242CrossRefGoogle Scholar
  47. 47.
    Milroy CM, Smith CL (1996) Sudden death due to a glial cyst of the pineal gland. J Clin Pathol 49:267–269PubMedCrossRefGoogle Scholar
  48. 48.
    Morgan JT, Scumpia AJ, Webster TM, Mittler MA, Edelman M, Schneider SJ (2008) Resting tremor secondary to a pineal cyst: case report and review of the literature. Pediatr Neurosurg 44:234–238PubMedCrossRefGoogle Scholar
  49. 49.
    Mukherjee KK, Banerji D, Sharma R (1999) Pineal cyst presenting with intracystic and subarachnoid hemorrhage: report of a case and review of the literature. Br J Neurosurg 13:189–192PubMedCrossRefGoogle Scholar
  50. 50.
    Musolino A, Cambria S, Rizzo G, Cambria M (1993) Symptomatic cyst of the pineal gland: stereotactic diagnosis and treatment of two cases and review of the literature. Neurosurgery 32:315–321PubMedCrossRefGoogle Scholar
  51. 51.
    Mutlu FM, Akin R, Uysal Y, Altinsoy HI, Bayraktar MZ (2006) Aicardi syndrome: an unusual case associated with pineal gland cyst and ventricular septal defect. J Child Neurol 21:1082–1084PubMedCrossRefGoogle Scholar
  52. 52.
    Nimmagadda A, Sandberg DI, Ragheb J (2006) Spontaneous involution of a large pineal region hemorrhagic cyst in an infant. Case report. J Neurosurg 104:275–278PubMedGoogle Scholar
  53. 53.
    Nolte I, Brockmann MA, Gerigk L, Groden C, Scharf J (2010) True FISP imaging of the pineal gland: more cysts and more abnormalities. Clin Neurol Neurosurg 112:204–208PubMedCrossRefGoogle Scholar
  54. 54.
    Oeckler R, Feiden W (1991) Benign symptomatic lesions of the pineal gland. Report of seven cases treated surgically. Acta Neurochir 108:40–44PubMedCrossRefGoogle Scholar
  55. 55.
    Osborn AG, Preece MT (2006) Intracranial cysts: radiologic–pathologic correlation and imaging approach. Radiology 239:650–664PubMedCrossRefGoogle Scholar
  56. 56.
    Ozek E, Ozek MM, Caliskan M, Sav A, Apak S, Erzen C (1995) Multiple pineal cysts associated with an ependymal cyst presenting with infantile spasm. Childs Nerv Syst 11:246–249PubMedCrossRefGoogle Scholar
  57. 57.
    Pastel DA, Mamourian AC, Duhaime AC (2009) Internal structure in pineal cysts on high-resolution magnetic resonance imaging: not a sign of malignancy. J Neurosurg Pediatr 4:81–84PubMedCrossRefGoogle Scholar
  58. 58.
    Patel AJ, Fuller GN, Wildrick DM, Sawaya R (2005) Pineal cyst apoplexy: case report and review of the literature. Neurosurgery 57:E1066PubMedCrossRefGoogle Scholar
  59. 59.
    Peres MF, Zukerman E, Porto PP, Brandt RA (2001) Headaches and pineal cyst: a (more than) coincidental relationship? Headache 44:929–930CrossRefGoogle Scholar
  60. 60.
    Peres MF, Masruha MR, Zukerman E, Moreira-Filho CA, Cavalheiro EA (2006) Potential therapeutic use of melatonin in migraine and other headache disorders. Expert Opin Investig Drugs 15:367–375PubMedCrossRefGoogle Scholar
  61. 61.
    Popovic MB, Balmer A, Maeder P, Braganca T, Munier FL (2006) Benign pineal cysts in children with bilateral retinoblastoma: a new variant of trilateral retinoblastoma? Pediatr Blood Cancer 46:755–761CrossRefGoogle Scholar
  62. 62.
    Popovic MB, Diezi M, Kuchler H, Abouzeid H, Maeder P, Balmer A, Munier FL (2007) Trilateral retinoblastoma with suprasellar tumor and associated pineal cyst. J Pediatr Hematol Oncol 29:53–56PubMedCrossRefGoogle Scholar
  63. 63.
    Pussep LM (1914) Die operative Entfernung einer Zyste der Glandula pinealis. Neurol Centmlbl 33:560–563Google Scholar
  64. 64.
    Pu Y, Mahankali S, Hou J, Li J, Lancaster JL, Gao JH, Appelbaum DE, Fox PT (2007) High prevalence of pineal cysts in healthy adults demonstrated by high-resolution, non contrast brain MR Imaging. AJNR Am J Neuroradiol 28:1706–1709PubMedCrossRefGoogle Scholar
  65. 65.
    Radovanovic I, Dizdarevic K, de Tribolet N, Masic T, Muminagic S (2009) Pineal region tumors–neurosurgical review. Med Arh 63:171–173PubMedGoogle Scholar
  66. 66.
    Raza SM, Recinos PF, Avendano J, Adams H, Jallo GI, Quinones-Hinojosa A (2011) Minimally invasive trans-portal resection of deep intracranial lesions. Minim Invasiv Neurosurg 54:5–11CrossRefGoogle Scholar
  67. 67.
    Richardson JK, Hirsch CS (1986) Sudden, unexpected death due to “pineal apoplexy”. Am J Forensic Med Pathol 7:64–68PubMedCrossRefGoogle Scholar
  68. 68.
    Rivarola MA, Belgorosky A, Mendilaharzu H, Vidal G (2001) Precocious puberty in children with tumours of the suprasellar and pineal areas: organic central precocious puberty. Acta Paediatr 90:751–756PubMedCrossRefGoogle Scholar
  69. 69.
    Sarikaya-Seiwert S, Turowski B, Hanggi D, Janssen G, Steiger HJ, Stummer W (2009) Symptomatic intracystic hemorrhage in pineal cyst. Report of 3 cases. J Neurosurg Pediatr 4:130–136PubMedCrossRefGoogle Scholar
  70. 70.
    Sarrazin S, Etain B, Vederine FE, d’Albis MA, Hamdani N, Daban C, Delavest M, Lepine JP, Leboyer M, Mangin JF, Poupon C, Houenou J (2011) MRI exploration of pineal volume in bipolar disorder. J Affect Disord 135:377–379PubMedCrossRefGoogle Scholar
  71. 71.
    Savas Erdeve S, Ocal G, Berberoglu M, Siklar Z, Hacihamdioglu B, Evliyaoglu O, Fitoz S (2011) The endocrine spectrum of intracranial cysts in childhood and review of the literature. J Pediatr Endocrinol Metab 24:867–875PubMedCrossRefGoogle Scholar
  72. 72.
    Sawamura Y, Ikeda J, Ozawa M, Minoshima Y, Saito H, Abe H (1995) Magnetic resonance images reveal a high incidence of asymptomatic pineal cyst in young women. Neurosurgery 37:11–16PubMedCrossRefGoogle Scholar
  73. 73.
    Schroeder HW, Wagner W, Tschiltschke W, Gaab MR (2001) Frameless neuronavigation in intracranial endoscopic neurosurgery. J Neurosurg 94:72–79PubMedCrossRefGoogle Scholar
  74. 74.
    Schwedt TJ, Guo Y, Rothner DA (2006) “Benign” imaging abnormalities in children and adolescents with headache. Headache 46:387–398PubMedCrossRefGoogle Scholar
  75. 75.
    Seifert CL, Woeller A, Valet M, Zimmer C, Berthele A, Tolle T, Sprenger T (2008) Headaches and pineal cyst: a case control study. Headache 48:448–452PubMedCrossRefGoogle Scholar
  76. 76.
    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 25:245–248PubMedCrossRefGoogle Scholar
  77. 77.
    Stern JD, Ross DA (1993) Stereotactic management of benign pineal region cysts: report of two cases. Neurosurgery 32:310–314PubMedCrossRefGoogle Scholar
  78. 78.
    Stevens QE, Colen CB, Ham SD, Kattner KA, Sood S (2007) Delayed lateral rectus palsy following resection of a pineal cyst in sitting position: direct or indirect compressive phenomenon? J Child Neurol 22:1411–1414PubMedCrossRefGoogle Scholar
  79. 79.
    Sugiyama K, Arita K, Okamura T, Yamasaki F, Kajiwara Y, Ueda H, Kurisu K (2002) Detection of a pineablastoma with large central cyst in a young child. Childs Nerv Syst 18:157–160PubMedCrossRefGoogle Scholar
  80. 80.
    Sun B, Wang D, Tang Y, Fan L, Lin X, Yu T, Qi H, Li Z, Liu S (2009) The pineal volume: a three-dimensional volumetric study in healthy young adults using 3.0 T MR data. Int J Dev Neurosci 27:655–660PubMedCrossRefGoogle Scholar
  81. 81.
    Swaroop GR, Whittle IR (1998) Pineal apoplexy: an occurrence with no diagnostic clinicopathologic features. Br J Neurosurg 12:274–276PubMedCrossRefGoogle Scholar
  82. 82.
    Tajima Y, Minami N, Sudo K, Moriwaka F, Tashiro K (1993) Hot water epilepsy with pineal cyst and cavum septi pellucidi. Jpn J Psychiatry Neurol 47:111–114PubMedGoogle Scholar
  83. 83.
    Tamaki N, Shirataki T, Lin TK, 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 5:172–176PubMedCrossRefGoogle Scholar
  84. 84.
    Taraszewska A, Matyja E, Koszewski W, Zaczynski A, Bardadin K, Czernicki Z (2008) Asymptomatic and symptomatic glial cyst of the pineal gland. Folia Neuropathol 46:186–195PubMedGoogle Scholar
  85. 85.
    Tirakotai W, Schulte DM, Bauer BL, Bertalanffy H, Hellwig D (2004) Neuroendoscopic surgery of intracranial cyst in adults. Childs Nerv Syst 20:842–851PubMedCrossRefGoogle Scholar
  86. 86.
    Tomita T (2008) Pineal region tumors. In: Albright AE, Pollack IF, Adelson PD (eds) Principles and practice of pediatrics neurosurgery, 2nd edn. Thieme Medical Publishers, New York, pp 585–560Google Scholar
  87. 87.
    Turtz AR, Hughes WB, Goldman HW (1995) Endoscopic treatment of a symptomatic pineal cyst: technical case report. Neurosurgery 37:1013–1015PubMedCrossRefGoogle Scholar
  88. 88.
    Uschold T, Abla AA, Fusco D, Bristol RE, Nakaji P (2011) Supracerebellar infratentorial endoscopically controlled resection of pineal lesions: case series and operative technique. J Neurosurg Pediatr 8:554–564PubMedCrossRefGoogle Scholar
  89. 89.
    Vorkapic P, Pendl G (1987) Microsurgery of pineal region lesions in children. Neuropediatrics 18:222–226PubMedCrossRefGoogle Scholar
  90. 90.
    Wisoff JH, Epstein F (1992) Surgical management of symptomatic pineal cysts. J Neurosurg 77:896–900PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • Gokmen Kahilogullari
    • 1
  • Luca Massimi
    • 2
    • 3
    Email author
  • Concezio Di Rocco
    • 2
  1. 1.Department of NeurosurgeryUniversity of AnkaraAnkaraTurkey
  2. 2.Pediatric NeurosurgeryCatholic University Medical SchoolRomeItaly
  3. 3.Institute of Neurosurgery–Pediatric NeurosurgeryA. Gemelli HospitalRomeItaly

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