Microsurgical Resection of Symptomatic Pineal Cysts

Authors: Š. Čapek 1,2;  J. Škvor 3;  E. Neubertová 4;  M. Sameš 1
Authors‘ workplace: Neurochirurgická klinika UJEP a Krajská zdravotní a. s., Masarykova nemocnice v Ústí nad Labem, o. z. 1;  Mezinárodní centrum klinického výzkumu, FN u sv. Anny v Brně 2;  Dětská klinika UJEP a Krajská zdravotní a. s., Masarykova nemocnice v Ústí nad Labem, o. z. 3;  Biolab, Praha k. s. 4
Published in: Cesk Slov Neurol N 2014; 77/110(1): 90-95
Category: Short Communication


The aim of the study was to review surgically treated patients with a pineal cyst with respect to an indication, therapy and outcome, and to provide an A to Z summary of pineal cysts spanning embryology to therapeutic possibilities.

Material and methods:
We retrospectively evaluated patients treated at the Department of Neurosurgery, Masaryk’s Hospital in Usti nad Labem between 2002 and 2012. All demographic data, symptoms, investigations and management data were recorded and evaluated.

Eight patients underwent a surgery (all female, median age 15.5 years), infratentorial-supracerebellar approach was used in all cases and the mean size of the cyst was 21 × 16 mm. Six patients presented with “typical” symptoms (headache, nausea, faintness, visual impairment), one with precocious puberty and one with progressive comatose condition. Mean follow-up time was 2.7 years. After the surgery, symptoms resolved completely in five patients (including the patient with precocious puberty) and partially in three.

If correctly indicated, surgical resection is the optimal therapeutic approach to symptomatic pineal cysts. Based on our experience and published literature, we continue to consider the infratentorial-supracerebellar approach as a gold standard for surgical treatment of pineal cysts.

Key words:
pineal gland – epiphysis cerebri – cyst – surgery – headache

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manu­script met the ICMJE “uniform requirements” for biomedical papers.


1. Al-Holou WN, Maher CO, Muraszko KM, Garton HJL. The natural history of pineal cysts in children and young adults. J Neurosurg Pediatr 2010; 5(2): 162–166.

2. Fain JS, Tomlinson FH, Scheithauer BW, Parisi JE, Fletcher GP, Kelly PJ et al. Symptomatic glial cysts of the pineal gland. J Neurosurg 1994; 80(3): 454–460.

3. Seifert CL, Woeller A, Valet M, Zimmer C, Berthele A, Tölle T et al. Headaches and pineal cyst: a case-control study. Headache 2008; 48(3): 448–452.

4. Peres MF, Zukerman E, Porto PP, Brandt RA. Headaches and pineal cyst: a (more than) coincidental relationship? Headache 2004; 44(9): 929–930.

5. Pu Y, Mahankali S, Hou J, Li J, Lancaster JL, Gao JH et al. High prevalence of pineal cysts in healthy adults demonstrated by high-resolution, noncontrast brain MR imaging. AJNR Am J Neuroradiol 2007; 28(9): 1706–1709.

6. Wisoff JH, Epstein F. Surgical management of symptomatic pineal cysts. J Neurosurg 1992; 77(6): 896–900.

7. Lacroix-Boudhrioua V, Linglart A, Ancel PY, Falip C, Bougnères PF, Adamsbaum C. Pineal cysts in children. Insights Imaging 2011; 2(6): 671–678.

8. Dickerman RD, Stevens QE, Steide JA, Schneider SJ. Precocious puberty associated with a pineal cyst: is it disinhibition of the hypothalamic-pituitary axis? Neuro Endocrinol Lett 2004; 25(3): 173–175.

9. Kumar KVSH, Verma A, Modi KD, Rayudu BR. Precocious puberty and pineal cyst – an uncommon association. Indian Pediatr 2010; 47(2): 193–194.

10. Čihák R. Anatomie I. Praha: Grada 2001.

11. Campbell AW. Notes of two cases of dilatation of central cavity or ventricle of the pineal gland. Trans Pathol Soc 1899: 15–18.

12. Russel AE. Cysts of the pineal body. Trans Pathol Soc 1899: 15.

13. Garrod AE. Pineal cyst. Trans Pathol Soc 1899: 14–15.

14. Sener RN. The pineal gland: a comparative MR imaging study in children and adults with respect to normal anatomical variations and pineal cysts. Pediatr Radiol 1995; 25(4): 245–248.

15. Golzarian J, Balériaux D, Bank WO, Matos C, Flament-Durand J. Pineal cyst: normal or pathological? Neuroradiology 1993; 35(4): 251–253.

16. Mamourian AC, Towfighi J. Pineal cysts: MR imaging. AJNR Am J Neuroradiol 1986; 7(6): 1081–1086.

17. Sawamura Y, Ikeda J, Ozawa M, Minoshima Y, Saito H, Abe H. Magnetic resonance images reveal a high incidence of asymptomatic pineal cysts in young women. Neurosurgery 1995; 37(1): 11–16.

18. Al-Holou WN, Terman SW, Kilburg C, Garton HJL, Muraszko KM, Chandler WF et al. Prevalence and natural history of pineal cysts in adults. J Neurosurg 2011; 115(6): 1106–1114.

19. Al-Holou WN, Garton HJL, Muraszko KM, Ibrahim M, Maher CO. Prevalence of pineal cysts in children and young adults. Clinical article. J Neurosurg Pediatr 2009; 4(3): 230–236.

20. Hasegawa A, Ohtsubo K, Mori W. Pineal gland in old age; quantitative and qualitative morphological study of 168 human autopsy cases. Brain Res 1987; 409(2): 343–349.

21. Tapp E, Huxley M. The histological appearance of the human pineal gland from puberty to old age. J Pathol 1972; 108(2): 137–144.

22. Bregant T, Rados M, Derganc M, Neubauer D, Kostovic I. Pineal cysts – a benign consequence of mild hypoxia in a near-term brain? Neuro Endocrinol Lett 2011; 32(5): 663–666.

23. Gladstone RJ. Development and Histogenesis of the Human Pineal Organ. J Anat 1935; 69(4): 427–454.

24. Koenigsberg RA, Faro S, Marino R, Turz A, Goldman W. Imaging of pineal apoplexy. Clin Imaging 1996; 20(2): 91–94.

25. Cooper ER. The Human Pineal Gland and Pineal Cysts. J Anat 1932; 67(1): 28–46.

26. Klein P, Rubinstein LJ. Benign symptomatic glial cysts of the pineal gland: a report of seven cases and review of the literature. J Neurol Neurosurg Psychiatr 1989; 52(8): 991–995.

27. Maurer PK, Ecklund J, Parisi JE, Ondra S. Symptomatic pineal cyst: case report. Neurosurgery 1990; 27(3): 451–453.

28. Taraszewska A, Matyja E, Koszewski W, Zaczyński A, Bardadin K, Czernicki Z. Asymptomatic and symptomatic glial cysts of the pineal gland. Folia Neuropathol 2008; 46(3): 186–195.

29. Greenberg MS. Handbook of neurosurgery. Tampa/New York: Greenberg Graphics/Thieme Medical Publishers 2010.

30. McNeely PD, Howes WJ, Mehta V. Pineal apoplexy: is it a facilitator for the development of pineal cysts? Can J Neurol Sci 2003; 30(1): 67–71.

31. Fleege MA, Miller GM, Fletcher GP, Fain JS, Scheithauer BW. Benign glial cysts of the pineal gland: unusual imaging characteristics with histologic correlation. AJNR Am J Neuroradiol 1994; 15(1): 161–166.

32. Michielsen G, Benoit Y, Baert E, Meire F, Caemaert J. Symptomatic pineal cysts: clinical manifestations and management. Acta Neurochir (Wien) 2002; 144(3): 233–242.

33. Fakhran S, Escott EJ. Pineocytoma mimicking a pineal cyst on imaging: true diagnostic dilemma or a case of incomplete imaging? AJNR Am J Neuroradiol 2008; 29(1): 159–163.

34. Momozaki N, Ikezaki K, Abe M, Fukui M, Fujii K, Kishikawa T. Cystic pineocytoma – case report. Neurol Med Chir (Tokyo) 1992; 32(3): 169–171.

35. Hayashida Y, Hirai T, Korogi Y, Kochi M, Maruyama N, Yamura M et al. Pineal cystic germinoma with syncytiotrophoblastic giant cells mimicking MR imaging findings of a pineal cyst. AJNR Am J Neuroradiol 2004; 25(9): 1538–1540.

36. Karatza EC, Shields CL, Flanders AE, Gonzalez ME, Shields JA. Pineal cyst simulating pinealoblastoma in 11 children with retinoblastoma. Arch Ophthalmol 2006; 124(4): 595–597.

37. Barboriak DP, Lee L, Provenzale JM. Serial MR imaging of pineal cysts: implications for natural history and follow-up. AJR Am J Roentgenol 2001; 176(3): 737–743.

38. Beneš V, Mohapl M. Symptomatické cysty pineální krajiny – chirurgická léčba. Cesk Slov Neurol N 2001; 64/97(5): 280–284.

39. Mandera M, Marcol W, Bierzyńska-Macyszyn G, Kluczewska E. Pineal cysts in childhood. Childs Nerv Syst 2003; 19(10–11): 750–755.

40. Oeckler R, Feiden W. Benign symptomatic lesions of the pineal gland. Report of seven cases treated surgically. Acta Neurochir (Wien) 1991; 108(1–2): 40–44.

41. Ozek E, Ozek MM, Calişkan M, Sav A, Apak S, Erzen C. Multiple pineal cysts associated with an ependymal cyst presenting with infantile spasm. Childs Nerv Syst 1995; 11(4): 246–269.

42. Morgan JT, Scumpia AJ, Webster TM, Mittler MA, Edelman M, Schneider SJ. Resting tremor secondary to a pineal cyst: case report and review of the literature. Pediatr Neurosurg 2008; 44(3): 234–238.

43. Fetell MR, Bruce JN, Burke AM, Cross DT, Torres RA, Powers JM et al. Non-neoplastic pineal cysts. Neurology 1991; 41(7): 1034–1040.

44. Walker AB, English J, Arendt J, MacFarlane IA. Hypogonadotrophic hypogonadism and primary amenorrhoea associated with increased melatonin secretion from a cystic pineal lesion. Clin Endocrinol (Oxf) 1996; 45(3): 353–356.

45. Richardson JK, Hirsch CS. Sudden, unexpected death due to “pineal apoplexy”. Am J Forensic Med Pathol 1986; 7(1): 64–68.

46. Milroy CM, Smith CL. Sudden death due to a glial cyst of the pineal gland. J Clin Pathol 1996; 49(3): 267–269.

47. Mena H, Armonda RA, Ribas JL, Ondra SL, Rushing EJ. Nonneoplastic pineal cysts: a clinicopathologic study of twenty-one cases. Ann Diagn Pathol 1997; 1(1): 11–18.

48. Kreth FW, Schätz CR, Pagenstecher A, Faist M, Volk B, Ostertag CB. Stereotactic management of lesions of the pineal region. Neurosurgery 1996; 39(2): 280–289.

49. Stern JD, Ross DA. Stereotactic management of benign pineal region cysts: report of two cases. Neurosurgery 1993; 32(2): 310–314.

50. Tirakotai W, Schulte DM, Bauer BL, Bertalanffy H, Hellwig D. Neuroendoscopic surgery of intracranial cysts in adults. Childs Nerv Syst 2004; 20(11–12): 842–851.

51. Gore PA, Gonzalez LF, Rekate HL, Nakaji P. Endoscopic supracerebellar infratentorial approach for pineal cyst resection: technical case report. Neurosurgery 2008; 62 (3 Suppl 1): 108–109.

52. Uschold T, Abla AA, Fusco D, Bristol RE, Nakaji P. Supracerebellar infratentorial endoscopically controlled resection of pineal lesions: case series and operative technique. J Neurosurg Pediatr 2011; 8(6): 554–564.

53. Oppenheim H, Krause F. Operative Erfolge bei Geschwiilsten der Sehhügel und Vierhugelgegend. Bed Klin Wschr 1913: 2316–2322.

54. Zapletal B. Surgical approach to the region of incisura tentorii. Zentralbl Neurochir 1956; 16(2): 64–69.

55. Stein BM. The infratentorial supracerebellar approach to pineal lesions. J Neurosurg 1971; 35(2): 197–202.

56. Lindroos AC, Niiya T, Randell T, Romani R, Hernesniemi J, Niemi T. Sitting position for removal of pineal region lesions: the Helsinki experience. World Neurosurg 2010; 74(4–5): 505–513.

57. Kodera T, Bozinov O, Sürücü O, Ulrich NH, Burkhardt JK, Bertalanffy H. Neurosurgical venous considerations for tumors of the pineal region resected using the infratentorial supracerebellar approach. J Clin Neurosci 2011; 18(11): 1481–1485.

58. Di Chirico A, Di Rocco F, Velardi F. Spontaneous regression of a symptomatic pineal cyst after endoscopic third-ventriculostomy. Childs Nerv Syst 2001; 17(1–2): 42–46.

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