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60th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Benelux countries and Bulgaria

German Society of Neurosurgery (DGNC)

24 - 27 May 2009, Münster

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Symptomatic intracystic hemorrhage in pineal cysts: report of four cases and review of the literature

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  • S. Sarikaya-Seiwert - Neurochirurgische Klinik, Heinrich-Heine-Universität Düsseldorf
  • B. Turowski - Klinik für Radiologie, Heinrich-Heine-Universität Düsseldorf
  • G. Janßen - Klinik für Pädiatrische Onkologie, Hämatologie und Immunologie, Heinrich-Heine-Universität Düsseldorf
  • D. Hänggi - Neurochirurgische Klinik, Heinrich-Heine-Universität Düsseldorf
  • H.-J. Steiger - Neurochirurgische Klinik, Heinrich-Heine-Universität Düsseldorf
  • W. Stummer - Neurochirurgische Klinik, Heinrich-Heine-Universität Düsseldorf

Deutsche Gesellschaft für Neurochirurgie. 60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit den Benelux-Ländern und Bulgarien. Münster, 24.-27.05.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. DocP16-10

doi: 10.3205/09dgnc431, urn:nbn:de:0183-09dgnc4316

Published: May 20, 2009

© 2009 Sarikaya-Seiwert et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: Pineal cysts are common asymptomatic intracranial entities. At autopsy they are seen in about 40%. Occasionally they can lead to neurological symptoms through growth or due to intracystic hemorrhage. The purpose of the current report is to describe the clinical characteristics and treatment options in these rare, clinically symptomatic cases.

Methods: In the current study we illustrate the course of disease in four patients who developed neurological symptoms due to hemorrhage into a pineal cyst during a period of 18 months. Two of our patients had additional cerebral diseases, and regular magnetic resonance imaging (MRI) examinations had therefore been conducted. This circumstance allowed to document cyst growth and intracystic hemorrhage. The third and fourth patient presented with acute triventricular hydrocephalus and papilledema due to aqueductal stenosis caused by the pineal cyst with intracystic hemorrhage. In all four cases surgical excision of the pineal cysts with drainage of the intracystic hemorrhage via an infratentorial-supracerebellar approach was performed.

Results: After the occurrence of severe headaches and diplopia in our patient population MRI showed a fluid-fluid level due to intracystic hemorrhage in all cases. Furthermore, the surgical specimen consisted of a beige-brown cyst from which straw-colored fluid was drained. The histological examination revealed the characteristic structure of a benign pineal cyst in all cases with hemorrhagic residues in the form of hemosiderin deposits. All patients recovered fully after surgical removal of the cysts. Furthermore, resolution of occlusive hydrocephalus could be demonstrated in all cases with ventricular enlargement.

Conclusions: Pineal cysts without neurological symptoms are often discovered as incidental findings on cranial MRI. In contrast, neurological symptoms such as severe headache, diplopia or Parinaud's syndrome, may occur as a result of pineal apoplexy due to intracystic hemorrhage. Our cases confirm that MRI can identify intracystic hemorrhage by a characteristic fluid-level. Finally, our experience suggests that microsurgical resection of the cyst is an effective and curative treatment option.