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World Neurosurgery May 2024Pineal cysts are typically detected in around 1.3% to 4.3% of patients during routine magnetic resonance imaging (MRI) scans. The vast majority of pineal cysts are...
Pineal cysts are typically detected in around 1.3% to 4.3% of patients during routine magnetic resonance imaging (MRI) scans. The vast majority of pineal cysts are benign, asymptomatic, and typically do not necessitate surgical intervention. Large pineal cysts are known to cause hydrocephalus with its associated symptoms and thus can require in rare cases surgical resection. Even in the absence of hydrocephalus, selected patients with large pineal cysts causing headaches and visual disturbances can find relief after surgical resection. The supracerebellar infratentorial (SCIT) approach is widely used and represents an extraparenchymatous approach through a natural corridor to the pineal region. Performing this approach in a semisitting position allows for an optimal retraction of the cerebellum by gravity. We employ a minimally invasive paramedian SCIT approach for the resection of pineal cysts. In our experience, the paramedian SCIT approach allows for a less steep operating angle and a smaller craniotomy compared with the midline SCIT approach. We present a 24-year-old female complaining of headache. The initial MRI was conducted 2 years before surgery. Following the initial evaluation, the patient experienced progressive headaches without neurologic deficits. A subsequent MRI revealed enlargement of the pineal cyst, leading to the indication for surgical resection. The surgery was performed mainly under the operating microscope with endoscopic visualization in suitable situations as our small approach restricts bimanual dissection with an endoscope. In our experience, this approach provides a versatile and minimally invasive access to the pineal region, making it optimally suitable for pineal cysts requiring surgical resection.
Topics: Humans; Female; Pineal Gland; Microsurgery; Neurosurgical Procedures; Young Adult; Magnetic Resonance Imaging; Central Nervous System Cysts; Cysts; Cerebellum
PubMed: 38369105
DOI: 10.1016/j.wneu.2024.02.049 -
Rozhledy V Chirurgii : Mesicnik... 2016The pineal region is a deep-seated part of the brain surrounded by highly eloquent structures. Differential diagnosis of space-occupying lesions in this region... (Review)
Review
INTRODUCTION
The pineal region is a deep-seated part of the brain surrounded by highly eloquent structures. Differential diagnosis of space-occupying lesions in this region encompasses pineal gland cysts, pineal gland tumours, metastases, germ cell tumours, meningiomas, gliomas, hemangioblastomas and neuroectodermal tumours. A treatment strategy is based mainly on tumour anatomical characteristics and histological type. Except germinatous tumours, a surgical excision is the treatment of choice.
METHODS
Microsurgical approaches: The microsurgical supracerebellar-infratentorial approach is an essential approach to the pineal region. Despite certain risks, it allows a straightforward and completely extracerebral approach with a minimal cerebellar retraction. The other basic approach is the microsurgical occipital-transtentorial approach that is advantageous in patients with a supratentorial tumour extension or a steep tentorium. The interhemispheric-transcallosal approach and the transcortical-transventricular approach are possible options in selected cases.Endoscopic approaches: The neuroendoscopy provides a minimally invasive method to perform a tumour biopsy and to treat hydrocephalus in one session. Stereotactic biopsy: The stereotactic needle biopsy represents an alternative to the endoscopic biopsy in patients without hydrocephalus and in patients with dorsally located lesions inaccessible from the third ventricle.
CONCLUSION
Modern neurosurgery offers a rich variety of surgical approaches to the pineal region. The complexity of space-occupying lesions in this region requires an individualised treatment, a prudent preoperative planning and a meticulous surgical technique.
Topics: Humans; Biopsy; Brain Neoplasms; Diagnosis, Differential; Microsurgery; Neuroendoscopy; Neurosurgical Procedures; Patient Care Planning; Pineal Gland; Pinealoma; Risk Adjustment; Stereotaxic Techniques
PubMed: 27650561
DOI: No ID Found -
Postgraduate Medical Journal Oct 2010The pineal gland is important in structure, function and in the pathology that can affect it. The significance of the pathology of the gland and its adjacent structures... (Review)
Review
The pineal gland is important in structure, function and in the pathology that can affect it. The significance of the pathology of the gland and its adjacent structures is twofold: anatomical location, and biological behaviour of many of the lesions. The gland is in a critical anatomic location, and as the dorsal portions of the midbrain are compressed, patients may present with obstructive hydrocephalus, and/or with focal neurology. Masses and tumours of the pineal region range widely in behaviour, from the completely benign (eg, pineal cyst) to highly malignant (eg, pineoblastoma). Masses in the pineal region may be benign cysts (most common mass), tumours of various sources as well as rare vascular malformations that result in mass effect. Tumours of the pineal region represent a variety of histologies. Germ cell tumours are the most common: germinomas (50%), teratoma (15%), and choricocarcinoma (5%). Primary tumours of the pineal region make up 15% of all pineal tumours and represent a spectrum of aggressiveness. Other less common tumours also occur in the pineal region including metastatic spread and direct invasion from tumours arising in adjacent structures. Accurate diagnosis is essential to plan appropriate management, and early referral for medical imaging is a necessary first step. Although there is significant overlap in the imaging characteristics of some pineal masses, a distinction between aggressive and benign lesions is usually possible, and invaluable preoperative information is obtained in patients who require histological diagnosis.
Topics: Brain Neoplasms; Cysts; Humans; Neoplasms, Germ Cell and Embryonal; Pineal Gland; Pinealoma; Tomography, X-Ray Computed
PubMed: 20971711
DOI: 10.1136/pgmj.2009.087460 -
Cephalalgia : An International Journal... Sep 2010The main known function of the pineal gland in humans is the production of melatonin. Benign cysts of the gland have been related to headache, although the mechanism of... (Review)
Review
The main known function of the pineal gland in humans is the production of melatonin. Benign cysts of the gland have been related to headache, although the mechanism of production of this assumed clinical manifestation has not been clearly determined, due to the lack of large prospective studies. The question is complicated by the fact that pineal cysts are frequently found on brain magnetic resonance imaging. Much has been published about the possible role of benign pineal cysts in the pathophisiology of headaches and the potential of melatonin in headache therapy, as well as in other disorders. The aim of this article is to review the current state of the subject. We have tried to place accurately the relation between headache and pineal cysts based on the available evidence, as well as the actual role of melatonin in physiology and pharmacology, more specifically in headache therapy. We include a clinical case to illustrate the subject.
Topics: Chronic Disease; Cluster Headache; Cysts; Female; Humans; Melatonin; Middle Aged; Migraine Disorders; Pineal Gland
PubMed: 20799383
DOI: 10.1177/0333102409359467 -
Headache Oct 2004Pineal cysts are common findings in neuroimaging studies. The cysts are more frequent in women in their third decade of life. Pineal cysts can be symptomatic, headache...
Pineal cysts are common findings in neuroimaging studies. The cysts are more frequent in women in their third decade of life. Pineal cysts can be symptomatic, headache is the most common symptom. The pineal gland has important physiological implications in humans, but little is known about the impact of pineal cysts in human physiology. We report 5 headache patients with pineal cyst, 4 women, 1 man, mean age 37.6, mean cyst diameter 10.1 mm. Two patients had migraine without aura, 1 migraine with aura, 1 chronic migraine, and 1 hemicrania continua. Three patients had strictly unilateral headaches. We hypothesize pineal cysts may be not incidental in headache patients, inducing an abnormal melatonin secretion.
Topics: Adolescent; Adult; Brain Neoplasms; Child; Cysts; Female; Headache; Humans; Male; Middle Aged; Pineal Gland
PubMed: 15447706
DOI: 10.1111/j.1526-4610.2004.04178_2.x -
Neuro-Chirurgie 2015The sitting position for pineal tumour removal remains controversial as regards the number of potential complications despite good surgical conditions. (Review)
Review
INTRODUCTION
The sitting position for pineal tumour removal remains controversial as regards the number of potential complications despite good surgical conditions.
METHOD
A systematic review of the literature was conducted in order to record the most frequent complications observed in this position, their incidence and prevention.
RESULTS
Venous air embolism, hypotension, pneumocephalus, macroglossia, quadriplegia and nerve injuries are the most frequent complications observed. Their incidence can be dramatically decreased with an accurate anesthesiological and neurosurgical management.
CONCLUSION
In training teams, the sitting position remains the gold standard for pineal tumour removal.
Topics: Anesthetics; Embolism, Air; Humans; Intraoperative Complications; Monitoring, Intraoperative; Neurosurgical Procedures; Pineal Gland
PubMed: 25676910
DOI: 10.1016/j.neuchi.2014.10.110 -
Medical Hypotheses Mar 2017
Topics: Adult; Brain Neoplasms; Cysts; Female; Homeostasis; Humans; Incidental Findings; Magnetic Resonance Imaging; Melatonin; Migraine Disorders; Models, Theoretical; Pain; Pineal Gland; Stress Disorders, Post-Traumatic; Vision, Ocular
PubMed: 28236855
DOI: 10.1016/j.mehy.2017.01.021 -
Current Problems in Cancer Jun 2023
Topics: Humans; Pineal Gland; Brain Neoplasms; Treatment Outcome; Ventriculostomy
PubMed: 36870166
DOI: 10.1016/j.currproblcancer.2023.100954 -
Neuro-Chirurgie 2015The knowledge of the incidence of pineal tumours is important not only for diagnostic care but also for its therapeutic programme. We reviewed the incidence of pineal... (Review)
Review
The knowledge of the incidence of pineal tumours is important not only for diagnostic care but also for its therapeutic programme. We reviewed the incidence of pineal tumours reported in literature in an attempt to establish if a difference existed between pineal gland tumours and the pineal region tumours as different authors use both expressions to indicate the same thing. The rate of frequency of these tumours is useful to guide the therapeutic choice for patients as the decisional tree is completely different for either germ cell tumours, pineal gland tumours or pineal gliomas and eventually papillary tumours of the pineal region. According to the French Register of pineal tumours, true pineal tumours represent: 27% pineal parenchymal tumours (PPT), 27% germ cell tumours, 17% gliomas, 8% papillary tumours. True pineal gland tumours are represented by: pineocytomas - (13%), pineal parenchymal tumours with intermediary differentiation PTT-ID - (66%) and pinealoblastomas - (21%). There was no statistical difference found between the French register and the Lyon series concerning histological diagnosis. It seemed to us important to discover its true incidence by comparing the data published in the literature and to stress the utility of the French Register for these uncommon tumours not only for recording new histological cases but also to document clinical symptomatology, therapeutic programmes, length of follow-up and clinical results for each patient treated. A better understanding of their natural history and improved evaluation of different treatments and their complications should contribute to improve clinical results.
Topics: Brain Neoplasms; Glioma; Humans; Incidence; Neoplasms, Germ Cell and Embryonal; Pineal Gland; Pinealoma
PubMed: 25113513
DOI: 10.1016/j.neuchi.2014.01.005 -
World Neurosurgery May 2018The pineal gland has been demonstrated to be involved in the development of mood and psychotic disorders. However, few studies have looked at the relationship between...
BACKGROUND
The pineal gland has been demonstrated to be involved in the development of mood and psychotic disorders. However, few studies have looked at the relationship between pineal region tumors and psychiatric disorders. Intracranial epidermoid cysts usually arise in the cerebellopontine angle area and are extremely rare in the pineal region. The case of pineal epidermoid cyst presenting as schizophrenia has never been reported before.
CASE PRESENTATION
We described the case of a 23-year-old man who presented to the hospital with symptoms suggestive of schizophrenia. During work-up, he was found to have a pineal lesion on brain magnetic resonance imaging. Total resection of the tumor was subsequently performed, and pathology confirmed an epidermoid cyst. One month after surgery, the patient's psychotic symptoms significantly improved free of drug and fully returned to work 3 months postoperatively.
CONCLUSIONS
This case highlights the importance of including mass lesions of the pineal region in the differential diagnosis of psychotic disorders. It also provides further support that the pineal region may play a role in the pathophysiology of psychiatric diseases, although more studies will be needed to elucidate this interesting connection.
Topics: Brain Neoplasms; Central Nervous System Cysts; Epidermal Cyst; Humans; Male; Pineal Gland; Schizophrenia; Young Adult
PubMed: 29524701
DOI: 10.1016/j.wneu.2018.02.151