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Acta Neurochirurgica Apr 2016A pineal cyst is a benign affection of a pineal gland on the borderline between a pathological lesion and a variant of normality. Clinical management of patients with a...
BACKGROUND
A pineal cyst is a benign affection of a pineal gland on the borderline between a pathological lesion and a variant of normality. Clinical management of patients with a pineal cyst remains controversial, especially when patients present with non-specific symptoms.
METHODS
An online questionnaire consisting of 13 questions was completed by 110 neurosurgeons worldwide. Responses were entered into a database and subsequently analysed.
RESULTS
Based on data from the questionnaire, the main indication criteria for pineal cyst resection are hydrocephalus (90 % of the respondents), Parinaud's syndrome (80 %) and growth of the cyst (68 %). Only 15 % of the respondents occasionally operate on patients with non-specific symptoms. If surgery is indicated, improvement is expected in 88 % of the patients. The vast majority of the respondents favour a supracerebellar infratentorial approach to the pineal region. Most (78 %) of the respondents regarded the patient registry as a potentially useful instrument.
CONCLUSIONS
This survey sheds light on the current practice of pineal cyst management across the world. Most of the respondents perform surgery on pineal cysts only if patients are presenting with symptoms attributable to a mass effect. Surgery for patients with non-specific complaints (headache, vertigo) is not widely accepted, although it may prove effective. A prospective patient registry might be useful in the decision-making process in the clinical management of pineal cysts.
Topics: Adult; Central Nervous System Cysts; Decision Making; Disease Management; Female; Humans; Male; Neurosurgeons; Neurosurgical Procedures; Pineal Gland; Practice Patterns, Physicians'; Surveys and Questionnaires
PubMed: 26897024
DOI: 10.1007/s00701-016-2726-3 -
Neuro-Chirurgie 2015In cases of pineal tumors, a germ cell tumor should always be suspected. As some of them are secreting tumors, tumoral markers (AFP and/or hGC) are an important part of... (Review)
Review
In cases of pineal tumors, a germ cell tumor should always be suspected. As some of them are secreting tumors, tumoral markers (AFP and/or hGC) are an important part of the diagnostic process. Their positivity either in the serum and/or in the cerebrospinal fluid may lead to an accurate diagnosis, avoiding a potentially dangerous surgical biopsy. Follow-up of tumoral markers is useful during and after treatment in order to monitor response to chemotherapy or a remission status.
Topics: Biomarkers, Tumor; Biopsy; Brain Neoplasms; Humans; Neoplasms, Germ Cell and Embryonal; Pineal Gland; Pinealoma
PubMed: 24856314
DOI: 10.1016/j.neuchi.2013.12.006 -
American Journal of Clinical Pathology May 2015To report a case of primary rhabdomyosarcoma (RMS) of the pineal gland in an adult, as well as review the literature on this rare entity. (Review)
Review
OBJECTIVES
To report a case of primary rhabdomyosarcoma (RMS) of the pineal gland in an adult, as well as review the literature on this rare entity.
METHODS
The case is compared with previous reports of similar entities, with emphasis on this patient's characteristics and clinical presentation, investigations, and management.
RESULTS
Diagnosis of primary RMS of the pineal gland was based on the presence of strap cells and multinucleated myotube-like structures, as well as tumor cell expression of skeletal muscle markers consistent with myogenic differentiation. Multimodality treatment was initiated based on pediatric protocols. Unfortunately, the disease progressed on treatment, and the patient survived only 5 months from diagnosis.
CONCLUSIONS
Pineal RMS is a rare disease with poor prognosis. Optimal management is unknown but likely to involve aggressive multimodality therapy.
Topics: Adult; Biomarkers, Tumor; Brain Neoplasms; Diagnosis, Differential; Fatal Outcome; Female; Humans; Pineal Gland; Rhabdomyosarcoma; Tomography, X-Ray Computed
PubMed: 25873508
DOI: 10.1309/AJCP9ZON4ZIHODIG -
Child's Nervous System : ChNS :... Dec 2023Pineal region cysts (PCs) may affect the tectum and aqueduct and cause deep central vein congestion. Beside headaches, PC often causes a broad range of symptoms, leading...
PURPOSE
Pineal region cysts (PCs) may affect the tectum and aqueduct and cause deep central vein congestion. Beside headaches, PC often causes a broad range of symptoms, leading to prolonged diagnosis and therapy. The aims of this study are to reveal parameters that might explain the ambiguity of the symptoms and to identify factors in association with the respiration-driven neurofluid system.
METHODS
This retrospective study included 28 paediatric patients (mean age 11.6 years) who received surgical treatment and 18 patients (mean age 11.3 years) who were followed conservatively. Symptoms, time to diagnosis, cyst size, ventricular indices, head circumference and postoperative outcome, were analysed. Four patients were investigated for CSF dynamics with real-time MRI. The mean follow-up time was 1.6 years.
RESULTS
The most common early onset symptoms were headaches (92%), blurred vision (42.8%), sleep disturbances (39.3%) and vertigo (32.1%). Tectum contact was observed in 82% of patients, and MRI examinations revealed that imaging flow void signals were absent in 32.1% of patients. The maximal cyst diameters were 13.7 × 15.6 mm (mean). Together with a postoperative flow void signal, 4 patients recovered their respiration-driven CSF aqueductal upward flow, which was not detectable preoperatively. After surgery the main symptoms improved.
CONCLUSION
Despite proximity to the aqueduct with frequently absent flow void signals, hydrocephalus was never detected. Data from real-time MRI depicted a reduced preoperative filling of the ventricular CSF compartments, indicating a diminished fluid preload, which recovered postoperatively.
Topics: Humans; Child; Retrospective Studies; Brain Neoplasms; Central Nervous System Cysts; Hydrocephalus; Cysts; Magnetic Resonance Imaging; Headache; Pineal Gland
PubMed: 37261536
DOI: 10.1007/s00381-023-06000-4 -
Neurological Research Apr 2023Neuroendoscopic resection supracerebellar infratentorial (SCIT) approach is adequate for some indicated pineal region tumors with the natural infratentorial corridor.... (Review)
Review
OBJECTIVE
Neuroendoscopic resection supracerebellar infratentorial (SCIT) approach is adequate for some indicated pineal region tumors with the natural infratentorial corridor. We described this full endoscopic approach through a modified 'head-up' park-bench position to facilitate the procedure.
METHODS
We reviewed the clinical and radiological data of four patients with pineal region lesions who underwent pure endoscopic tumor resection through the SCIT approach with this modified position. The related literature concerning fully endoscopic pineal region tumor resection was also reviewed.
RESULTS
This cohort included four patients with pineal region tumors. External ventricular drainage (Ommaya reservoir) was performed in three patients with hydrocephalus in advance. The average tumor volume was 19.2 ± 17.2 cm. Pathological examination confirmed two mixed germinomas, one glioblastoma multiforme, and one hemangioblastoma. Gross total resection (GTR) was achieved in all patients, and all patients recovered well without neurological deficits or surgical complications. Hydrocephalus was relieved among all patients.
CONCLUSIONS
The pure endoscopic SCIT approach could enable safe and effective resection of pineal region tumors, even for relatively large lesions. The endoscope could provide a panoramic view and illumination of the deep-seated structures. Compared with the sitting position, this modified ergonomic position could be implemented easily.
Topics: Humans; Sitting Position; Neurosurgical Procedures; Pinealoma; Pineal Gland; Neuroendoscopy; Brain Neoplasms
PubMed: 36509700
DOI: 10.1080/01616412.2022.2146266 -
Progress in Experimental Tumor Research 1987
Review
Topics: Brain Neoplasms; Child; Dysgerminoma; Female; Humans; Male; Methods; Pineal Gland
PubMed: 3306798
DOI: 10.1159/000413685 -
Neurologia Medico-chirurgica May 1998A 21-year-old male presented with a pineal dermoid cyst manifesting as headache and diplopia. He had undergone gross total removal of a pineal mature teratoma 18 years...
A 21-year-old male presented with a pineal dermoid cyst manifesting as headache and diplopia. He had undergone gross total removal of a pineal mature teratoma 18 years before and had done well until recently. Diffusion-weighted magnetic resonance imaging showed a region of high signal intensity due to a round mass in the pineal region and extending into the trigone of the right lateral ventricle. Subtotal excision of the tumor was achieved. Histological examination showed an epidermoid cyst consisting of keratinized stratified squamous epithelium and connective tissue. Intraoperative observation had detected black hairs, so the diagnosis was dermoid cyst. The dermoid cyst may have arisen from a microscopic remnant of the cyst wall of the original pineal mature teratoma. The regrowth of a dermoid cyst 18 years after gross total removal of a mature cystic teratoma in the pineal region is exceptional. However, careful follow-up of patients who undergo gross total removal of a pineal teratoma is recommended for a period more than that of the patient's age at surgery plus 9 months.
Topics: Adolescent; Adult; Brain Neoplasms; Dermoid Cyst; Follow-Up Studies; Humans; Male; Neoplasms, Second Primary; Pineal Gland; Pinealoma; Reoperation
PubMed: 9640967
DOI: 10.2176/nmc.38.297 -
Child's Nervous System : ChNS :... Dec 2020We present a consecutive case series and a systematic review of surgically treated pediatric PCs. We hypothesized that the symptomatic PC is a progressive disease with... (Review)
Review
INTRODUCTION
We present a consecutive case series and a systematic review of surgically treated pediatric PCs. We hypothesized that the symptomatic PC is a progressive disease with hydrocephalus at its last stage. We also propose that PC microsurgery is associated with better postoperative outcomes compared to other treatments.
METHODS
The systematic review was conducted in PubMed and Scopus. No clinical study on pediatric PC patients was available. We performed a comprehensive evaluation of the available individual patient data of 43 (22 case reports and 21 observational series) articles.
RESULTS
The review included 109 patients (72% females). Ten-year-old or younger patients harbored smaller PC sizes compared to older patients (p < 0.01). The pediatric PCs operated on appeared to represent a progressive disease, which started with unspecific symptoms with a mean cyst diameter of 14.5 mm, and progressed to visual impairment with a mean cyst diameter of 17.8 mm, and hydrocephalus with a mean cyst diameter of 23.5 mm in the final stages of disease (p < 0.001). Additionally, 96% of patients saw an improvement in their symptoms or became asymptomatic after surgery. PC microsurgery linked with superior gross total resection compared to endoscopic and stereotactic procedures (p < 0.001).
CONCLUSIONS
Surgically treated pediatric PCs appear to behave as a progressive disease, which starts with cyst diameters of approximately 15 mm and develops with acute or progressive hydrocephalus at the final stage. PC microneurosurgery appears to be associated with a more complete surgical resection compared to other procedures.
Topics: Brain Neoplasms; Central Nervous System Cysts; Child; Cysts; Female; Humans; Male; Microsurgery; Pineal Gland
PubMed: 32691194
DOI: 10.1007/s00381-020-04792-3 -
Neurology India 2021Anaplastic ependymoma in the pineal region is rare. Here, we present a rare case of anaplastic ependymoma of the pineal region on a 42-year-old woman who came to our...
Anaplastic ependymoma in the pineal region is rare. Here, we present a rare case of anaplastic ependymoma of the pineal region on a 42-year-old woman who came to our hospital with headache associated with blurring of vision since one month. MRI brain showed a contrast enhancing mass lesion measuring 30 × 30 × 35 mm in the pineal region with obstructive hydrocephalus. Initially, the ventriculoperitoneal (VP) shunt was done, followed by total tumor excision by the infratentorial supracerebellar approach. Histopathological and immunohistochemistry examinations of the tumor showed the features of anaplastic ependymoma (WHO Grade III). Patient made uneventful recovery and underwent radiotherapy. Only 12 cases of pineal ependymoma have been reported so far, of which only three have been anaplastic ependymoma.
Topics: Adult; Ependymoma; Female; Humans; Hydrocephalus; Magnetic Resonance Imaging; Pineal Gland; Ventriculoperitoneal Shunt
PubMed: 34507442
DOI: 10.4103/0028-3886.325365 -
The Pan African Medical Journal 2020An 11-year-old boy presenting with sudden onset double vision, headache and neck pain was found to have left lateral rectus palsy, papilledema and neck rigidity. An...
An 11-year-old boy presenting with sudden onset double vision, headache and neck pain was found to have left lateral rectus palsy, papilledema and neck rigidity. An initial diagnosis of benign intracranial hypertension was considered. However, magnetic resonance imaging (MRI) of the brain surprisingly discovered the pineal gland cyst. He underwent Krause´s procedure for the excision biopsy of the cyst. Histopathological examination confirmed epidermoid cyst. Postoperatively, he had transient ataxia and upgaze palsy but recovered well. He was asymptomatic during the first and third-month follow-ups. The case highlights the unusual presentation of a rare intracranial tumor, pineal epidermoid cyst. Neuroimaging and timely surgery lead to a good outcome.
Topics: Abducens Nerve Diseases; Child; Diplopia; Epidermal Cyst; Headache; Humans; Magnetic Resonance Imaging; Male; Neck Pain; Papilledema; Pineal Gland; Pseudotumor Cerebri
PubMed: 33014248
DOI: 10.11604/pamj.2020.36.252.24378