Article
Resection of pineal cysts – to do or not to do
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Authors
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Ahmed El Damaty
- Department of Neurosurgery, Heidelberg University, Heidelberg, Deutschland
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Steffen Fleck
- Universitätsmedizin Greifswald , Klinik und Poliklinik für Neurochirurgie , Greifswald, Deutschland
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Henry W. S. Schroeder
- Ernst-Moritz-Arndt-Universität Greifswald, Klinik und Poliklinik für Neurochirurgie, Greifswald, Deutschland
| Published: | June 9, 2017 |
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Outline
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Objective: Surgical indications for patients with pineal cysts are controversial. There are absolute indications for resection as hydrocephalus or tectal compression symptoms but there are some relative indications that are difficult to decide whether a surgical treatment would be beneficial or not. We tried to clarify the indications of resection in cases of pineal cysts in the shadow of our experience.
Methods: We reviewed retrospectively our database for all patients who underwent a surgical resection for a pineal cyst from 2003 to 2016. We studied the presenting symptoms, the size of the cyst, the used surgical approach and the extent of resection, the clinical and radiological follow-up. The follow up period ranged from 6 months to 11 years.
Results: We found 30 patients that have been operated for a pineal cyst. The presenting symptoms were headache in 28 patients, nausea and vomiting (18), visual disturbances (10), dizziness (9) and gait unsteadiness (1). In three patients, only an endoscopic fenestration was done, two of them were re-operated two and five years later with a recurrence due to occlusion of the fenestration, the third patient was completely free during follow-up without evidence of closure of the fenestration. All other patients underwent a microsurgical total resection through a supracerebellar infratentorial approach. Nineteen patients were free of symptoms after surgery. Preoperative symptoms improved in 9 patients. Two patients reported whether development of new symptoms after surgery in the form of behavioral changes or memory disturbance or no improvement of pre-existing symptoms. Only 5 patients have ventriculomegaly before surgery including the 3 patients operated through endoscopic fenestration.
Conclusion: We suppose that the indication for pineal cyst resection should be widened to include patients with small ventricles when the pattern of the headache suggests a temporary increase in intracranial pressure, i.e. headache as a symptom rather than those of hydrocephalus and tectal compression. Obviously, some cysts may cause slight aqueductal compression which leads to temporary increased intracranial pressure due to a valve mechanism.
