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70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

12.05. - 15.05.2019, Würzburg

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Infratentorial supracerebellar pineal cyst resection in the absence of ventriculomegaly – indication and clinical outcome – a single-centre experience

Pinealiszysten ohne Ventrikelerweiterung-Infratentorielle supracerebelläre Resektion – Indikation und Outcome

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  • presenting/speaker Steffen K. Fleck - Universitätsmedizin Greifswald, Klinik für Neurochirurgie, Greifswald, Deutschland
  • Marc Matthes - Universitätsmedizin Greifswald, Klinik für Neurochirurgie, Greifswald, Deutschland
  • Ahmed El Damaty - Universität Heidelberg, Klinik für Neurochirurgie, Heidelberg, Deutschland
  • Sascha Marx - Universitätsmedizin Greifswald, Klinik für Neurochirurgie, Greifswald, Deutschland
  • Ehab El Refaee - Universitätsmedizin Greifswald, Klinik für Neurochirurgie, Greifswald, Deutschland; Universität Kairo, Klinik für Neurochirurgie, Kairo, Egypt
  • Jörg Baldauf - Universitätsmedizin Greifswald, Klinik für Neurochirurgie, Greifswald, Deutschland
  • Henry Schroeder - Universitätsmedizin Greifswald, Klinik für Neurochirurgie, Greifswald, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie. Würzburg, 12.-15.05.2019. Düsseldorf: German Medical Science GMS Publishing House; 2019. DocV205

doi: 10.3205/19dgnc220, urn:nbn:de:0183-19dgnc2209

Veröffentlicht: 8. Mai 2019

© 2019 Fleck et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.

Gliederung

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Objective: Pineal cysts are relatively common with an incidence of 25-40% in autopsy studies. The majority of pineal cysts are found incidentally on MR imaging. Surgical indications for patient with pineal cysts are still under debate: Secondary hydrocephalus and Parinaud-syndrome are well-described indications for an operation. Pineal cysts without a secondary ventriculomegaly due to permanent (visible) CSF pathway obstruction may also cause certain symptoms (e.g. headache, dizziness, vomiting, visual disturbances, sleep problems). To further clarify the role of surgery in these circumstances, we prospectively analysed our patient cohort.

Methods: We documented all patients with a pineal cyst in the absence of enlarged ventricles surgically treated between 2003 to 2018. These patients were operated viaan infratentorial supracerebellar approach. Symptoms, cyst size, extent of resection, radiographic and clinical follow-up were analysed pre- and postoperatively within a mean follow-up period of 25.7 months (Range: 1–134 months).

Results: During the period, 50 patients were operated on a pineal cyst. An absence of enlarged ventricles could be documented in 43 patients (36 female, 7 male, mean age 25.63 yrs (±10.62 yrs), range 4–52 yrs).

Presented symptoms included headache (41/43), visual disturbances (10/43), dizziness (18/43), sleep disturbances (8/43). The mean cyst size was 15.73 mm (range 9–27 mm). Complete cyst resection could be achieved in 37/43 patients

86% (37/43) of patients described a complete (20/43) or partial (17/43) resolution of the leading symptoms.

Conclusion: We suggest that pineal cysts can be operated also in the absence of ventriculomegaly. The postoperative resolution of quality of life limiting symptoms in our series demonstrate a good indication for pineal cyst resection. Preoperatively, other causes of the leading symptoms have to be excluded. Intermittent occlusion of the aqueduct may cause increased intracranial pressure leading to intermittent symptoms.