Article
Infratentorial supracerebellar pineal cyst resection in the absence of ventriculomegaly – indication and clinical outcome – a single-centre experience
Mikrochirurgische infratentoriell-supracerebelläre Resektion von Pinealiszysten ohne Hydrozephalus – Indikation und klinisches Ergebnis – monozentrische Erfahrung
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Authors
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Steffen K. Fleck
- Universitätsmedizin Greifswald, Klinik für Neurochirurgie, Greifswald, Deutschland
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Ina Lange
- Universitätsmedizin Greifswald, Klinik für Neurochirurgie, Greifswald, Deutschland
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Marc Matthes
- Universitätsmedizin Greifswald, Klinik für Neurochirurgie, Greifswald, Deutschland
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Ehab El Refaee
- Universitätsmedizin Greifswald, Klinik für Neurochirurgie, Greifswald, Deutschland; Universität Kairo, Klinik für Neurochirurgie, Kairo, Ägypten
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Ahmed El Damaty
- Ruprecht-Karls-Universität Heidelberg, Klinik für Neurochirurgie, Heidelberg, Deutschland
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Jörg Baldauf
- Universitätsmedizin Greifswald, Klinik für Neurochirurgie, Greifswald, Deutschland
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Sascha Marx
- Universitätsmedizin Greifswald, Klinik für Neurochirurgie, Greifswald, Deutschland
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Henry W. S. Schroeder
- Universitätsmedizin Greifswald, Klinik für Neurochirurgie, Greifswald, Deutschland
| Published: | June 4, 2021 |
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Outline
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Objective: The majority of pineal cysts are found incidentally on MR imaging. Secondary hydrocephalus and Parinaud-syndrome are well-described indications for an operation. However, the indication for surgery of pineal cysts without ventriculomegaly is still under debate. Pineal cysts may cause symptoms (e.g. headache, dizziness, vomiting, visual disturbances, sleep problems) without showing dilation of the ventricles. To further clarify the role of surgery in pineal cysts without ventriculomegaly, we prospectively analysed our patient cohort.
Methods: We collected all patients with a pineal cyst in the absence of enlarged ventricles treated surgically between 2003 and 2020. All patients were operated via an microsurgical infratentorial supracerebellar approach. Symptoms, cyst size, extent of resection, radiographic and clinical follow-up were analyzed pre- and postoperatively within a mean follow-up period of 21.6 months (Range: 1-134 month).
Results: 74 patients underwent surgery for a pineal cyst. An absence of enlarged ventricles could be documented in 64 patients (53 female, 11 male, mean age 27.7 yrs (±12 yrs), range 4-59 yrs). Presenting symptoms included headache (62/64), visual disturbances (16/64), dizziness (29/64), sleep disturbances (12/64). The mean cyst size was 15.17 mm (range 7-27 mm). Complete cyst resection was achieved in 61/64 patients. 61 of 64 (95%) patients improved after operation with good or even excellent results according to the Chicago Chiari Outcome Scale (CCOS ≥ 12), with complete or partial resolution of the leading symptoms.
Conclusion: Surgical resection of pineal cysts may be an indication even in the absence of ventriculomegaly. The postoperative resolution of quality-of-life impairing symptoms in our series demonstrates a good indication for pineal cyst resection. Preoperatively, other causes of the leading symptoms have to be excluded. Intermittent occlusion of the aqueduct or compression of the internal cerebral veins may cause increased intracranial pressure leading to intermittent symptoms.
