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Demir F, Demir S, Baskan F. Conservative management of pediatric pineal cyst apoplexy: a case report and literature review. Childs Nerv Syst 2025; 41:80. [PMID: 39751845 DOI: 10.1007/s00381-024-06734-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2024] [Accepted: 12/19/2024] [Indexed: 01/04/2025]
Abstract
A 5-month-old male patient presented with obstructive hydrocephalus caused by pineal cyst apoplexy. Ventriculoperitoneal shunt surgery was performed for hydrocephalus treatment. During follow-up, spontaneous shrinkage of the cyst was observed. At 24 months of follow-up, no complications were reported. Pediatric cases of pineal cyst apoplexy are rare, and little is known about its conservative management. This case report emphasizes the effectiveness of conservative treatment and close monitoring, aiming to contribute to the understanding of pineal cyst apoplexy management in the pediatric population.
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Affiliation(s)
- Fırat Demir
- Department of Neurosurgery, Health Science University, Basaksehir Cam and Sakura City Hospital, Basaksehir, Istanbul, Turkey.
| | - Suat Demir
- Department of Neurosurgery, Health Science University, Basaksehir Cam and Sakura City Hospital, Basaksehir, Istanbul, Turkey
| | - Fikret Baskan
- Department of Neurosurgery, Faculty of Medicine, Biruni University, Istanbul, Turkey
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de Bloeme CM, Jansen RW, de Haan J, Pieperjohanns D, Casseri T, Gironi F, Pasca A, Ketteler P, Moll AC, Koob M, Sirin S, Maeder P, Galluzzi P, Göricke S, de Graaf P, de Jong MC. Follow-up of Cystic Pineal Glands in Retinoblastoma Patients Does Not Increase Detection of Pineal Trilateral Retinoblastoma. Am J Ophthalmol 2024; 268:199-211. [PMID: 38992673 DOI: 10.1016/j.ajo.2024.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 06/14/2024] [Accepted: 07/02/2024] [Indexed: 07/13/2024]
Abstract
PURPOSE To evaluate the effectiveness of baseline screening and follow-up with magnetic resonance imaging (MRI) for detecting trilateral retinoblastoma (TRb) and assessing the risk of TRb development. DESIGN Prospective multicenter cohort study. METHODS A total of 607 retinoblastoma patients from 2012 through 2022 were included and followed up until September 1, 2023. At each center, a neuroradiologist categorized pineal glands on baseline and follow-up scans into 4 groups: (A) normal, (B) cystic gland, (C) suspicious gland, or (D) TRb. Different follow-up schedules were assigned to each category. Categories B and C were followed up with MRI after approximately 3 months and repeated 3 months later if suspicion remained. On each MRI, they measured the height and width, evaluated the aspect (solid, partly cystic, and completely cystic) of the pineal gland, and evaluated radiologic features suspicious of pineal TRb. The effectiveness of the current TRb screening method was assessed by evaluating its sensitivity and specificity to detect TRb. Determining the TRb incidence was a secondary outcome measure. RESULTS Heritable retinoblastoma patients had a risk of 3.78% to develop TRb. One of 4 pineal TRbs was detected during a follow-up scan and 4 of 5 nonpineal TRbs were detected on the baseline MRI. Screening for pineal TRb had a sensitivity of 25% and specificity of 100%; for nonpineal TRb, the sensitivity was 80%. It required 494 follow-up scans to detect 1 pineal TRb. However, when restricting the follow-up to solely suspicious glands, only 22 scans were required to detect 1 pineal TRb. CONCLUSION During extended follow-up after baseline MRI, only 1 pineal trilateral retinoblastoma was detected in our study. Follow-up after 3 months should be restricted to patients with a suspicious pineal gland defined as irregular thickening of the cyst wall (>2 mm), fine nodular aspect of the cyst wall, or when a solid or cystic gland exceeds the upper 99% prediction interval for size; patients with an unsuspicious cystic gland should not be followed up. Baseline MRI screening was able to detect most nonpineal trilateral retinoblastomas.
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Affiliation(s)
- Christiaan M de Bloeme
- From the European Retinoblastoma Imaging Collaboration (ERIC) (C.M.d.B., R.W.J., M.K., S.S., P.M., P.G., S.G., P.d.G., M.C.d.J.); Cancer Center Amsterdam, Imaging and Biomarkers (C.M.d.B., R.W.J., J.d.H., A.C.M., P.d.G., M.C.d.J.), Amsterdam, the Netherlands; Department of Radiology and Nuclear Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam (C.M.d.B., R.W.J., J.d.H., P.d.G., M.C.d.J.), Amsterdam, the Netherlands.
| | - Robin W Jansen
- From the European Retinoblastoma Imaging Collaboration (ERIC) (C.M.d.B., R.W.J., M.K., S.S., P.M., P.G., S.G., P.d.G., M.C.d.J.); Cancer Center Amsterdam, Imaging and Biomarkers (C.M.d.B., R.W.J., J.d.H., A.C.M., P.d.G., M.C.d.J.), Amsterdam, the Netherlands; Department of Radiology and Nuclear Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam (C.M.d.B., R.W.J., J.d.H., P.d.G., M.C.d.J.), Amsterdam, the Netherlands
| | - Joeka de Haan
- Cancer Center Amsterdam, Imaging and Biomarkers (C.M.d.B., R.W.J., J.d.H., A.C.M., P.d.G., M.C.d.J.), Amsterdam, the Netherlands; Department of Radiology and Nuclear Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam (C.M.d.B., R.W.J., J.d.H., P.d.G., M.C.d.J.), Amsterdam, the Netherlands
| | - Debbie Pieperjohanns
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen (D.P., S.G.), Essen, Germany
| | - Tommaso Casseri
- Department of Neuroimaging and Neurointervention, Siena University Hospital (T.C., P.G.), Siena, Italy
| | - Federica Gironi
- Department of Neuroimaging and Neurointervention, Siena University Hospital (T.C., P.G.), Siena, Italy; Department of Pediatrics and Neonatology, Siena University Hospital (F.G., A.P.), Siena, Italy
| | - Alessandra Pasca
- Department of Pediatrics and Neonatology, Siena University Hospital (F.G., A.P.), Siena, Italy
| | - Petra Ketteler
- Department of Pediatric Oncology, University Hospital Essen (P.K.), Essen, Germany
| | - Annette C Moll
- Cancer Center Amsterdam, Imaging and Biomarkers (C.M.d.B., R.W.J., J.d.H., A.C.M., P.d.G., M.C.d.J.), Amsterdam, the Netherlands; Department of Ophthalmology, Amsterdam UMC, Vrije Universiteit Amsterdam (A.C.M.), Amsterdam, the Netherlands
| | - Meriam Koob
- From the European Retinoblastoma Imaging Collaboration (ERIC) (C.M.d.B., R.W.J., M.K., S.S., P.M., P.G., S.G., P.d.G., M.C.d.J.); Department of Radiology, Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne (M.K., P.M.), Lausanne, Switzerland
| | - Selma Sirin
- From the European Retinoblastoma Imaging Collaboration (ERIC) (C.M.d.B., R.W.J., M.K., S.S., P.M., P.G., S.G., P.d.G., M.C.d.J.); Department of Diagnostic Imaging, University Children's Hospital Zurich, University of Zurich (S.S.), Zurich, Switzerland
| | - Philippe Maeder
- From the European Retinoblastoma Imaging Collaboration (ERIC) (C.M.d.B., R.W.J., M.K., S.S., P.M., P.G., S.G., P.d.G., M.C.d.J.); Department of Radiology, Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne (M.K., P.M.), Lausanne, Switzerland
| | - Paolo Galluzzi
- From the European Retinoblastoma Imaging Collaboration (ERIC) (C.M.d.B., R.W.J., M.K., S.S., P.M., P.G., S.G., P.d.G., M.C.d.J.); Department of Neuroimaging and Neurointervention, Siena University Hospital (T.C., P.G.), Siena, Italy
| | - Sophia Göricke
- From the European Retinoblastoma Imaging Collaboration (ERIC) (C.M.d.B., R.W.J., M.K., S.S., P.M., P.G., S.G., P.d.G., M.C.d.J.); Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen (D.P., S.G.), Essen, Germany
| | - Pim de Graaf
- From the European Retinoblastoma Imaging Collaboration (ERIC) (C.M.d.B., R.W.J., M.K., S.S., P.M., P.G., S.G., P.d.G., M.C.d.J.); Cancer Center Amsterdam, Imaging and Biomarkers (C.M.d.B., R.W.J., J.d.H., A.C.M., P.d.G., M.C.d.J.), Amsterdam, the Netherlands; Department of Radiology and Nuclear Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam (C.M.d.B., R.W.J., J.d.H., P.d.G., M.C.d.J.), Amsterdam, the Netherlands
| | - Marcus C de Jong
- From the European Retinoblastoma Imaging Collaboration (ERIC) (C.M.d.B., R.W.J., M.K., S.S., P.M., P.G., S.G., P.d.G., M.C.d.J.); Cancer Center Amsterdam, Imaging and Biomarkers (C.M.d.B., R.W.J., J.d.H., A.C.M., P.d.G., M.C.d.J.), Amsterdam, the Netherlands; Department of Radiology and Nuclear Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam (C.M.d.B., R.W.J., J.d.H., P.d.G., M.C.d.J.), Amsterdam, the Netherlands
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Freire I, Falsitta LV, Sharma C, Löbel U, Sudhakar S, Biswas A, Cooper J, Mankad K, Hilal K, Duncan C, D'Arco F. Pineal gland ADC values in children aged 0 to 4 years: normative data and usefulness in the differential diagnosis with trilateral retinoblastoma. Neuroradiology 2024:10.1007/s00234-024-03479-9. [PMID: 39365330 DOI: 10.1007/s00234-024-03479-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2024] [Accepted: 09/30/2024] [Indexed: 10/05/2024]
Abstract
PURPOSE Normative ADC values of the pineal gland in young children are currently lacking, however, these are potentially useful in the differential diagnosis of pineal involvement in trilateral retinoblastoma, which is challenging when the size of the tumor is less than 10-15 mm. The main objective of this study was to establish ADC reference values of the normal pineal gland in a large cohort of children between 0 and 4 years. METHODS This retrospective study was conducted in a tertiary pediatric hospital. We collected 64 patients with normal MRI examination (between 2017 and 2024) and clinical indication unrelated to the pineal gland, and divided them into 5 age groups (0 to 4 years). Gland size and mean ADC values were calculated, using the ellipsoid formula and ROI/histogram analysis, respectively. The established values were tested in three cases of trilateral retinoblastoma (10 to 20 months). RESULTS Mean ADC values were always above 1000 × 10- 6 mm2/s, while in patients with trilateral retinoblastoma they were around 800 × 10- 6 mm2/s. Pineal ADC values were identical in both genders. The volume of the pineal gland showed a tendency to increase with age. CONCLUSIONS We present ADC reference data for the pineal gland in children under 4 years of age. The distribution of mean ADC values of trilateral retinoblastoma was significantly different from the normative values, hence, the use DWI/ADC may help to identify small trilateral retinoblastoma in children with ocular pathology.
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Affiliation(s)
- Inês Freire
- Department of Neuroradiology, Hospital de S. José, Unidade Local de Saúde São José, Rua José António Serrano, Lisboa, Arroios, 1150-199, Portugal.
- Centro Clínico Académico de Lisboa, Lisboa, Portugal.
| | | | - Chetan Sharma
- Department of Radiology, Southern Health and Social Care Trust, Portadown, Northern Ireland, UK
| | - Ulrike Löbel
- Department of Radiology, Neuroradiology Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Sniya Sudhakar
- Department of Radiology, Neuroradiology Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Asthik Biswas
- Department of Radiology, Neuroradiology Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Jessica Cooper
- Department of Radiology, Neuroradiology Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Kshitij Mankad
- Department of Radiology, Neuroradiology Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Kiran Hilal
- Department of Radiology, Aga Khan University Hospital, Karachi, Pakistan
| | - Catriona Duncan
- Department of Oncology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Felice D'Arco
- Department of Radiology, Neuroradiology Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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Kılınç Uğurlu A, Özdemir Gökce A, Çakır Gündoğan S, Ekşioğlu AS, Boyraz M. MRI evaluation of cranial pathologies in rapidly progressive early puberty cases aged 8-9. Front Endocrinol (Lausanne) 2024; 14:1316333. [PMID: 38229738 PMCID: PMC10789853 DOI: 10.3389/fendo.2023.1316333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 12/05/2023] [Indexed: 01/18/2024] Open
Abstract
Purpose The aim of this study was to investigate the frequency and distribution of intracranial pathologies in female patients between 8 and 9 years of age who were diagnosed with early puberty (rapidly progressive) through the evaluation of MRI images. Materials and methods A total of 74 female patients diagnosed with central precocious puberty (CPP) (6-8 years) and rapidly progressive early puberty (RPEP) (8-9 years) were included in the study. The patients were categorized into two groups, normal and abnormal, based on the findings from their MRI scans. Recent literature has classified abnormal MRI findings into three groups: pathological findings, findings with a questionable relationship to CPP, and incidental findings. Furthermore, the patients were divided into four groups based on their MRI findings and whether they had CPP or RPEP : CPP (6-8 years) +Normal MRI, RPEP (8-9 years) + Normal MRI, CPP (6-8 years) +Abnormal MRI, RPEP (8-9 years) +Abnormal MRI. Results Out of the 74 girls included in the study, 54% (n=40) showed normal MRI results, while abnormal MRI findings were detected in 46% (n = 34) of the cases. No malignant lesions were identified among cases with abnormal MRI findings. The occurrence of abnormal MRI findings was observed in 46% of the PP group and 45% of the RPEP group. Incidental findings were the most common MRI findings in both groups. The proportion of cases with pathological findings and findings with a questionable relationship to CPP was similar in both groups (p = 0.06). Basal luteinizing hormone (LH) concentration was found to be higher in the RPEP (8-9 years) +Abnormal MRI group compared to the CPP (6-8 years) +Normal MRI group (p = 0.01). Conclusion Our study is the first to investigate MRI findings in cases of rapidly progressive early puberty in the age range of 8-9 years. Our study demonstrates that there is no difference in terms of intracranial findings between cases of precocious puberty at the age of 6-8 years and cases of rapidly progressive early puberty aged 8-9.
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Affiliation(s)
- Aylin Kılınç Uğurlu
- Ankara Bilkent City Hospital, Pediatric Endocrinology Clinic, Ankara, Türkiye
| | - Ayse Özdemir Gökce
- Ankara Bilkent City Hospital, Pediatric Radiology Clinic, Ankara, Türkiye
| | | | | | - Mehmet Boyraz
- Ankara Bilkent City Hospital, Pediatric Endocrinology Clinic, Ankara, Türkiye
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Szathmari A, Vasiljevic A, Di Rocco F, Beuriat PA, Mottolese C. Pineal cysts in children: a paediatric series treated over the last twenty years in Lyon. Childs Nerv Syst 2023; 39:3467-3474. [PMID: 37898987 DOI: 10.1007/s00381-023-06181-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 10/10/2023] [Indexed: 10/31/2023]
Abstract
BACKGROUND Pineal cysts are a rare lesion of the pineal gland. Pineal cysts are benign lesions, generally asymptomatic, and are usually an incidental discovery on MRI performed for other problems. The management of pineal cysts in children remains a matter for debate. Here, we report our own retrospective paediatric cases that have been surgically treated and review the paediatric literature on this topic. METHODS This is a retrospective monocentric study. All patients operated by the senior author (CM) for a benign pineal cyst from 2000 to 2021 were included. All other pineal region cystic lesions were excluded. Medical and surgical data were extracted from the hospital medical database. RESULTS Twelve patients were included. The clinical symptomatology was characterized by headaches in seven patients, visual troubles in two patients, precocious puberty in one patient, signs of intracranial hypertension in two patients, seizures associated with headache in one patient, and headaches associated with behavioural troubles in another patient. No major post-operative complications were observed in this series. It is to noted that surgery was performed because a suspicion of a true pineal parenchymal tumour has been made. Histopathological study came back with the diagnosis of pineal cyst. CONCLUSIONS Pineal cyst is rare. If the radiological diagnosis is clear, no surgery is advocated except in cases associated with hydrocephalus and rapid growth. In case of a suspicion of a true pineal parenchymal tumour, a surgery may be needed to confirm the diagnosis. Lastly, we stress that only cystic lesions of the pineal gland itself should be considered as pineal cyst.
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Affiliation(s)
- Alexandru Szathmari
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 32 Avenue du Doyen Jean Lépine, 69500, Bron, France
| | - Alexandre Vasiljevic
- Department of Pathology and Neuropathology, GHE, Hospices Civils de Lyon, 69500, Bron, France
| | - Federico Di Rocco
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 32 Avenue du Doyen Jean Lépine, 69500, Bron, France
- Université Claude Bernard, Lyon 1, 69100, Villeurbanne, France
| | - Pierre-Aurélien Beuriat
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 32 Avenue du Doyen Jean Lépine, 69500, Bron, France
- Université Claude Bernard, Lyon 1, 69100, Villeurbanne, France
| | - Carmine Mottolese
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 32 Avenue du Doyen Jean Lépine, 69500, Bron, France.
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Warsza B, Due-Tønnessen P, Due-Tønnessen P, Pripp A, Ringstad G, Eide PK. Prevalence of pineal cysts in healthy individuals: Emphasis on size, morphology and pineal recess crowding. J Neurol Sci 2023; 453:120801. [PMID: 37741123 DOI: 10.1016/j.jns.2023.120801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 09/08/2023] [Accepted: 09/09/2023] [Indexed: 09/25/2023]
Abstract
The present study aimed to determine prevalence of non-hydrocephalic pineal cysts of different size and morphology in healthy individuals. In a cohort of healthy individuals who as part of research volunteered to undergo magnetic resonance imaging (MRI) of the brain, we performed a systematic search for occurrence of pineal cysts of different sizes, morphology and evidence of crowding of the pineal recess. Degree of crowding in the pineal recess was estimated by the imaging biomarkers anterior-posterior diameter and cyst-tectum-splenium (CTS) ratio at midsagittal MRI. The study included a cohort of 994 healthy individuals, aged 47.0 ± 21.1 years in whom a pineal cyst was demonstrated in 337/994 (37.5%) individuals. A small cyst within a mainly solid gland was observed in 252/994 (25.4%) subjects and a mainly cystic gland in121/994 (12.2%). The pineal cysts were more frequent in women than men, and were associated with age, though not with reduced prevalence in aged individuals, as previously reported. Cysts with maximum anterior-posterior diameter ≥ 10 mm were seen in 51/994 (5.1%) individuals, and with CTS ratio ≥ 0.9 in 16/994 (1.6%) individuals. The occurrence of pineal cysts is frequent and is seen more frequently in women. It usually presents as a small cyst in a predominantly solid gland; however, pineal cysts causing crowding of the pineal recess with a CTS ratio ≥ 0.9 was seen in merely 1.6% of participants.
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Affiliation(s)
- Bogna Warsza
- Department of Radiology, Oslo University Hospital-Rikshospitalet, Oslo, Norway
| | | | - Paulina Due-Tønnessen
- Clinic for Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway; Department of Psychology, University of Oslo, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Are Pripp
- Oslo Centre of Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway; Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Geir Ringstad
- Department of Radiology, Oslo University Hospital-Rikshospitalet, Oslo, Norway; Department of Geriatrics and Internal Medicine, Sorlandet Hospital, Arendal, Norway
| | - Per K Eide
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Neurosurgery; Oslo University Hospital-Rikshospitalet, Oslo, Norway.
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Vasiljevic A. Histopathology and molecular pathology of pediatric pineal parenchymal tumors. Childs Nerv Syst 2023; 39:2273-2284. [PMID: 35972537 DOI: 10.1007/s00381-022-05637-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 08/02/2022] [Indexed: 11/24/2022]
Abstract
Pineal parenchymal tumors in children are rare. They consist of two main types, pineoblastoma (PB) and pineal parenchymal tumor of intermediate differentiation (PPTID), which are World Health Organization (WHO) grade 4 and grade 2-3 respectively. PBs are divided into four distinct molecular groups: PB-miRNA1, PB-miRNA2, PB-RB1, and PB-MYC/FOXR2. PB-RB1 and PB-MYC/FOXR2 affect young children and are associated with a dismal prognosis. PB-miRNA1 and PB-miRNA2 groups affect older children and follow a more favorable course. They are characterized by mutually exclusive alterations in genes involved in miRNA biogenesis, including DICER1, DROSHA, and DGCR8. They may be sporadic or may represent one manifestation of DICER1 syndrome. PB-RB1 tumors show alterations in the RB1 gene and may develop in the setting of congenital retinoblastoma, a condition known as "trilateral retinoblastoma." In the pediatric population, PPTIDs typically affect adolescents. They are characterized by small in-frame insertions in the KBTBD4 gene which is involved in ubiquitination.
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Affiliation(s)
- Alexandre Vasiljevic
- Centre de Pathologie Et Neuropathologie Est, Groupement Hospitalier Est, Hospices Civils de Lyon, 59 Boulevard Pinel, 69677 BRON Cedex, Lyon, France.
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Guadix SW, Marianayagam NJ, Weidman EK, Yuan M, Liechty B, Greenfield JP, Souweidane MM. Defining Occult High-Risk Cysts of the Pineal Region: A Case Series. Oper Neurosurg (Hagerstown) 2023; 24:572-581. [PMID: 36716050 DOI: 10.1227/ons.0000000000000620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 11/08/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Absence of hydrocephalus on neuroimaging may impart a false sense of security for patients with pineal cysts. In this case series, we characterize a subset of patients with pineal cysts having an occult presentation. Unifying features of worsening paroxysmal headaches suggesting intermittent obstructive hydrocephalus and radiographic evidence of third ventricular invagination characterize these patients as high risk. OBJECTIVE To define features of occult, high-risk pineal cysts and outcomes of endoscopic cyst fenestration. METHODS Charts were retrospectively reviewed for patients with pineal cysts evaluated at our institution between 2018 and 2021 who underwent endoscopic cyst fenestration. To capture cysts presenting as occult, patients were excluded if hydrocephalus was noted at presentation. Relevant clinical history, imaging, operative data, and clinical outcomes were reviewed. RESULTS Of 50 pineal cyst patients, 4 satisfied inclusion criteria. All patients presented with worsening paroxysmal headaches. In addition, 75% (3/4) also experienced intermittent syncope. Patients exhibited no hydrocephalus (n = 3) or fluctuating ventricular size on longitudinal imaging (n = 1). In all cases, high-resolution sagittal 3-dimensional T2 magnetic resonance imaging demonstrated invagination of the cyst anteriorly into the posterior third ventricle. All patients underwent endoscopic cyst fenestration with complete symptom resolution (mean follow-up of 20.6 months; range 3.5-37.4 months). CONCLUSION The clinical history for occult, high-risk pineal cysts is notable for worsening paroxysmal headaches and episodic alterations of consciousness suggesting intermittent obstructive hydrocephalus. Because ventricular size can appear normal on standard imaging protocols, clinical suspicion should trigger workup with high-resolution magnetic resonance imaging designed to detect these cysts. Endoscopic cyst fenestration is a safe and efficacious management strategy.
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Affiliation(s)
- Sergio W Guadix
- Department of Neurological Surgery, Weill Cornell Medical Center, NewYork Presbyterian Hospital, New York, New York, USA
| | - Neelan J Marianayagam
- Department of Neurological Surgery, Weill Cornell Medical Center, NewYork Presbyterian Hospital, New York, New York, USA
| | - Elizabeth K Weidman
- Department of Radiology, Weill Cornell Medical Center, NewYork Presbyterian Hospital, New York, New York, USA
| | - Melissa Yuan
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Benjamin Liechty
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical Center, NewYork Presbyterian Hospital, New York, New York, USA
| | - Jeffrey P Greenfield
- Department of Neurological Surgery, Weill Cornell Medical Center, NewYork Presbyterian Hospital, New York, New York, USA
| | - Mark M Souweidane
- Department of Neurological Surgery, Weill Cornell Medical Center, NewYork Presbyterian Hospital, New York, New York, USA
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Eide PK, Lindstrøm EK, Pripp AH, Valnes LM, Ringstad G. Physiological alterations of pineal recess crowding in symptomatic non-hydrocephalic pineal cysts. Brain Commun 2023; 5:fcad078. [PMID: 37501910 PMCID: PMC10371044 DOI: 10.1093/braincomms/fcad078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 01/11/2023] [Accepted: 03/16/2023] [Indexed: 07/29/2023] Open
Abstract
Pineal cysts are prevalent in the population. Due to more widespread use of magnetic resonance imaging, an increasing number of symptomatic patients with non-hydrocephalic pineal cysts are referred to neurologists and neurosurgeons. Currently, there is no generally accepted theoretical framework for linking symptoms to a pineal cyst. We have previously suggested that cyst-induced crowding of the pineal recess may affect venous runoff from the deep cerebral veins crossing the cyst. However, evidence underpinning this hypothesis is sparse. In the present study, we asked whether crowding of the pineal recess without imaging signs of hydrocephalus may be accompanied with alterations in blood flow of the internal cerebral veins, cerebrospinal fluid flow in the Sylvian aqueduct and cerebrospinal fluid-mediated tracer clearance from the brain along extravascular pathways (referred to as glymphatic function). This prospective, observational study included symptomatic individuals with non-hydrocephalic pineal cysts who underwent a standardized magnetic resonance imaging protocol (n = 25): Eleven patients were treated surgically with craniotomy and cyst extirpation and 14 individuals were managed conservatively without surgery. Our findings suggest that cyst-induced crowding of the pineal recess may have brain-wide effects: (i) There was a significant negative correlation between degree of crowding within the pineal recess and change in maximum venous flow velocity at the cyst, and a significant positive correlation between maximum venous flow velocity change at the cyst and net cerebrospinal fluid flow in the Sylvian aqueduct; (ii) increased degree of crowding in the pineal recess was accompanied by significantly impaired glymphatic enrichment in the cerebral cortex and subcortical white matter, indicative of a brain-wide effect in this cohort who also reported markedly impaired subjective sleep quality; (iii) there was a significant negative correlation between the apparent diffusion coefficient (suggestive of interstitial water content) within the thalamus and glymphatic enrichment of tracer and (iv) pineal recess crowding associated with symptoms. Comparison of the surgical cases [in whom 10/11 (91%) reported marked clinical improvement at follow-up] and the conservatively managed cases [in whom 1/14 (7%) reported marked clinical improvement at follow-up] showed differences in pre-treatment glymphatic tracer enrichment as well as differences in tracer enrichment in subarachnoid cerebrospinal fluid spaces. Taken together, we interpret these observations to support the hypothesis that cyst-induced crowding of the pineal recess without hydrocephalus may alter blood flow of the internal cerebral veins and cerebrospinal fluid flow and even cause brain-wide impairment of glymphatic transport with possible implications for cerebrospinal fluid transport of trophic factors such as melatonin.
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Affiliation(s)
- Per Kristian Eide
- Correspondence to: Per Kristian Eide, MD, PhD Department of Neurosurgery Oslo University Hospital—Rikshospitalet Pb 4950 Nydalen, Sognvannsveien 20 N-0424 Oslo, Norway E-mail:
| | | | - Are Hugo Pripp
- Oslo Centre of Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, N-0424 Oslo, Norway
- Faculty of Health Sciences, Oslo Metropolitan University, N-0176 Oslo, Norway
| | - Lars Magnus Valnes
- Department of Neurosurgery, Oslo University Hospital—Rikshospitalet, N-0424 Oslo, Norway
| | - Geir Ringstad
- Department of Radiology, Oslo University Hospital- Rikshospitalet, N-0424 Oslo, Norway
- Department of Geriatrics and Internal Medicine, Sorlandet Hospital, N-4838 Arendal, Norway
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Dirik MA, Sanlidag B. Intracranial cysts: incidental or neurodevelopmental? Childs Nerv Syst 2023; 39:775-780. [PMID: 36323954 DOI: 10.1007/s00381-022-05724-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 10/25/2022] [Indexed: 03/04/2023]
Abstract
OBJECTIVES Intracranial cysts are fluid-filled sacs within the brain. There is a diversity of intracranial cysts with different incidences in addition to the growing awareness about comorbidities and the consequences. The present study aimed to evaluate cystic findings in children who were admitted to the department of pediatric neurology. METHODS Children who were admitted to the Clinic of Pediatric Neurology and who had an MRI between 2016 and 2021 were evaluated. The MRI examination was performed with the pediatric epilepsy protocol. Children with primary intracranial cysts were enrolled in the study. Demographic and clinical findings were evaluated from the hospital's database and patients' files. RESULTS Among the 78 patients, 36 (46.2%) were male and 42 (53.8%) were female. The mean age was 7 ± 5.4 years. The most frequent presenting complaint was a seizure (47.4%). Approximately one-quarter (28.2%) had mental and/or motor retardation. Nine (11.5%) of the children had a neuropsychiatric diagnosis. Most of the cysts were located at the midline (41%) with the majority located extra-axial (71.8%) and supratentorial (78.2%). Arachnoid cysts were observed most frequently with a percentage of 64.1%, followed by pineal cysts (15.4%). The history of seizure, epilepsy, presence of mental retardation, and neuropsychiatric problems were evaluated according to the population ratios based on z approximation in which significantly higher rates were observed among cases with intracranial cysts. CONCLUSION Intracranial cysts should be taken into consideration for comorbid pathologies, especially in the childhood period. Early evaluation in patients with intracranial cysts for developmental delay and neuropsychiatric problems is important.
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Affiliation(s)
- Mehmet Alp Dirik
- Faculty of Medicine, Department of Radiology, Dr Suat Gunsel University, Kyrenia, North Cyprus
- Faculty of Medicine, Near East University, Nicosia, North Cyprus
| | - Burcin Sanlidag
- Pediatric Neurology, Faculty of Medicine, Department of Pediatrics, Division of Pediatric Neurology, Near East University, Nicosia, North Cyprus.
- Faculty of Medicine, Dr Suat Gunsel University, Kyrenia, North Cyprus.
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11
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Hasegawa H, Inoue A, Helal A, Kashiwabara K, Meyer FB. Pineal cyst: results of long-term MRI surveillance and analysis of growth and shrinkage rates. J Neurosurg 2023; 138:113-119. [PMID: 35623363 DOI: 10.3171/2022.4.jns22276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 04/12/2022] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Pineal cyst (PC) is a relatively common true cyst in the pineal gland. Its long-term natural course remains ill defined. This study aims to evaluate the long-term natural history of PC and examine MRI risk factors for cyst growth and shrinkage to help better define which patients might benefit from surgical intervention. METHODS The records and MRI of 409 consecutive patients with PC were retrospectively examined (nonsurgical cohort). Cyst growth and shrinkage were defined as a ≥ 2-mm increase and decrease in cyst diameter in any direction, respectively. In addition to size, MRI signal intensity ratios were analyzed. RESULTS The median radiological follow-up period was 10.7 years (interquartile range [IQR] 6.4-14.3 years). The median change in maximal diameter was -0.6 mm (IQR -1.5 to 1.3 mm). During the observation period, cyst growth was confirmed in 21 patients (5.1%). Multivariate logistic regression analysis revealed that only age (odds ratio [OR] 0.96, 95% confidence interval [CI] 0.93-0.99, p < 0.01) was significantly associated with cyst growth. No patient required resection during the observation period. Cyst shrinkage was confirmed in 57 patients (13.9%). Multivariate analysis revealed that maximal diameter (OR 1.22, 95% CI 1.12-1.35, p < 0.01) and cyst CSF T2 signal intensity ratio (OR 9.06, 95% CI 1.38-6.62 × 101, p = 0.02) were significantly associated with cyst shrinkage. CONCLUSIONS Only 5% of PCs, mainly in patients younger than 50 years of age, have the potential to grow, while cyst shrinkage is more likely to occur across all age groups. Younger age is associated with cyst growth, while larger diameter and higher signal intensity on T2-weighted imaging are associated with shrinkage. Surgery is rarely needed for PCs, despite the possibility of a certain degree of growth.
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Affiliation(s)
- Hirotaka Hasegawa
- 1Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota.,2Department of Neurosurgery, University of Tokyo Hospital, Tokyo, Japan
| | - Akitoshi Inoue
- 3Department of Radiology, Mayo Clinic, Rochester, Minnesota; and
| | - Ahmed Helal
- 1Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Kosuke Kashiwabara
- 4Department of Biostatistics, School of Public Health, Graduate School of Medicine, University of Tokyo, Japan
| | - Fredric B Meyer
- 1Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
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12
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Konovalov A, Pitskhelauri D, Serova N, Shishkina L, Abramov I. Pineal cyst management: A single-institution experience spanning two decades. Surg Neurol Int 2022; 13:350. [PMID: 36128100 PMCID: PMC9479525 DOI: 10.25259/sni_130_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 07/20/2022] [Indexed: 11/22/2022] Open
Abstract
Background: Pineal cysts (PCs) are benign lesions commonly found on intracranial imaging. Despite their high prevalence, there is no clear consensus on the most appropriate management of patients with PCs, especially those with symptomatic nonhydrocephalic cysts. Methods: A retrospective analysis was performed on 142 patients with PCs (103 surgical cases and 39 conservatively managed cases). Data were examined, including clinical presentation, imaging findings, ophthalmological status, natural course, postoperative outcomes, and complications. Results: Surgical group: the most common symptom was headache (92%), followed by signs of intracranial hypertension due to hydrocephalus (22%). New radiological feature of PCs was found in 11 patients. From 71 patients with long-term follow-up, headache completely resolved in 44 (62%) patients; marked improvement was observed in 20 (29%); in 7 (9%) – headache remained unchanged. The most common postoperative complication was neuro-ophthalmological disorders (23%), with a tendency for resolution in the long-term follow-up period. Neuro-ophthalmological symptoms at last follow-up included upward gaze palsy (6%) and skew deviation (5%), followed by convergence disorders (3%) and eyelid-retraction (2%). Natural course group: PC size remained stable in 34 (87%) patients during the follow-up period. The patient’s gender or age was not a significant predictor of cyst growth (P = 0.4, P = 0.56). Conclusion: The majority of patients with a newly diagnosed PC remain clinically and radiologically stable. Patients with nonhydrocephalic PCs and intractable headaches experience significant relief in headache symptoms, but are at risk of mild to moderate neuro-ophthalmological disorders. The natural course of PCs and factors promoting their growth still remains poorly defined.
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Affiliation(s)
- Alexander Konovalov
- Department of Neurosurgery, Burdenko Neurosurgery Center, Moscow, Russian Federation
| | - David Pitskhelauri
- Department of Neurosurgery, Burdenko Neurosurgery Center, Moscow, Russian Federation
| | - Natalia Serova
- Department of Neuro-Ophthalmology, Burdenko Neurosurgery Center, Moscow, Russian Federation
| | - Lyudmila Shishkina
- Department of Neuropathology, Burdenko Neurosurgery Center, Moscow, Russian Federation
| | - Irakliy Abramov
- Department of Neurosurgery, Burdenko Neurosurgery Center, Moscow, Russian Federation
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13
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Hanna B, Robinson MW, Skoch J. Exclusively endoscopic management of complicated pineal cysts in young children: Definitive treatment through single burr-hole technique. Surg Neurol Int 2022; 13:281. [PMID: 35855169 PMCID: PMC9282818 DOI: 10.25259/sni_302_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 06/14/2022] [Indexed: 11/26/2022] Open
Abstract
Background: The management of complicated symptomatic pineal cysts in the pediatric population is challenging and variable. Surgical management may include treatment of hydrocephalus alone, or direct treatment of the cyst with or without direct hydrocephalus management. This is typically done through craniotomy-based microsurgical approaches to the pineal region or an endoscopic transventricular approach. Methods: We present a stepwise minimally invasive technique to treat complicated pineal cysts in young children associated with an obstructive hydrocephalus in a single procedure through third ventriculostomy combined with an intraventricular marsupialization of the pineal cyst through a single burr-hole using stereotactic navigation. Results: Two young patients with over 2 years of follow-up have done well without complication using this technique. Other literature reports for complex pineal cysts in pediatric patients are reviewed and this technique is not previously described for this population. Conclusion: Endoscopic third ventriculostomy and cyst marsupialization using a single burr-hole and stereotactic navigation for symptomatic or enlarging pineal cysts in children allow for minimally invasive management, a rapid recovery, short hospital stay, and durable outcome owed to redundant CSF flow pathways.
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Affiliation(s)
- Baher Hanna
- Department of Pediatric Neurosurgery, Cincinnati Children’s Medical Center, Cincinnati, Ohio, United States
| | - Michael W. Robinson
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
| | - Jesse Skoch
- Department of Pediatric Neurosurgery, Cincinnati Children’s Medical Center, Cincinnati, Ohio, United States
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14
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Paun L, Lavé A, Patet G, Bartoli A. Supratentorial Pediatric Midline Tumors and Tumor-like Lesions: Clinical Spectrum, Natural History and Treatment Options. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9040534. [PMID: 35455578 PMCID: PMC9032564 DOI: 10.3390/children9040534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/29/2022] [Accepted: 04/05/2022] [Indexed: 04/10/2023]
Abstract
Childhood Central Nervous System tumors account for 25% of all pediatric tumors. Large availability and broadening of indications to imaging has made incidental findings more common. Among these, midline lesions have different clinical relevance depending on their intrinsic pattern of behaviour and on their specific location. In this narrative review we describe the natural history and treatment options of midline lesions in children.
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15
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Pineal cysts without hydrocephalus: microsurgical resection via an infratentorial-supracerebellar approach-surgical strategies, complications, and their avoidance. Neurosurg Rev 2022; 45:3327-3337. [PMID: 35829978 PMCID: PMC9492705 DOI: 10.1007/s10143-022-01831-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 06/28/2022] [Accepted: 06/30/2022] [Indexed: 02/03/2023]
Abstract
Indications for surgery of pineal cysts without ventriculomegaly are still under debate. In view of the limited data for pineal cyst resection in the absence of hydrocephalus, and the potential risk of this approach, we have analyzed our patient cohort focusing on strategies to avoid complications according to our experience in a series of 73 pineal cyst patients. From 2003 to 2015, we reviewed our database retrospectively for all patients operated on a pineal cyst. Furthermore, we prospectively collected patients from 2016 to 2020. In summary, 73 patients with a pineal cyst were treated surgically between 2003 and 2020. All patients were operated on via a microscopic supracerebellar-infratentorial (SCIT) approach. The mean follow-up period was 26.6 months (range: 6-139 months). Seventy-three patients underwent surgery for a pineal cyst. An absence of enlarged ventricles was documented in 62 patients (51 female, 11 male, mean age 28.1 (range 4-59) years). Main presenting symptoms included headache, visual disturbances, dizziness/vertigo, nausea/emesis, and sleep disturbances. Complete cyst resection was achieved in 59/62 patients. Fifty-five of 62 (89%) patients improved after surgery with good or even excellent results according to the Chicago Chiari Outcome Scale, with complete or partial resolution of the leading symptoms. Pineal cysts resection might be an indication in certain patients for surgery even in the absence of ventriculomegaly. The high percentage of postoperative resolution of quality-of-life impairing symptoms in our series seems to justify surgery. Preoperatively, other causes of the leading symptoms have to be excluded.
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16
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Zaccagna F, Brown FS, Allinson KSJ, Devadass A, Kapadia A, Massoud TF, Matys T. In and around the pineal gland: a neuroimaging review. Clin Radiol 2021; 77:e107-e119. [PMID: 34774298 DOI: 10.1016/j.crad.2021.09.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 09/30/2021] [Indexed: 01/16/2023]
Abstract
Lesions arising in or around the pineal gland comprise a heterogeneous group of pathologies ranging from benign non-neoplastic cysts to highly malignant neoplasms. Pineal cysts are frequently encountered as an incidental finding in daily radiology practice but there is no universal agreement on the criteria for, frequency of, and duration of follow-up imaging. Solid pineal neoplasms pose a diagnostic challenge owing to considerable overlap in their imaging characteristics, although a combination of radiological appearances, clinical findings, and tumour markers allows for narrowing of the differential diagnosis. In this review, we describe the radiological anatomy of the pineal region, clinical symptoms, imaging appearances, and differential diagnosis of lesions arising in this area, and highlight the clinical management of these conditions.
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Affiliation(s)
- F Zaccagna
- Department of Radiology, University of Cambridge, Cambridge, UK; Division of Neuroimaging, Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - F S Brown
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - K S J Allinson
- Department of Pathology, Cambridge University NHS Foundation Trust, Cambridge, UK
| | - A Devadass
- Department of Pathology, Cambridge University NHS Foundation Trust, Cambridge, UK
| | - A Kapadia
- Division of Neuroimaging, Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - T F Massoud
- Division of Neuroimaging and Neurointervention, Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - T Matys
- Department of Radiology, University of Cambridge, Cambridge, UK.
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17
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Montaser AS, Cho EY, Catalino MP, Hanna J, Smith TR, Laws ER. A Surgical Perspective on the Association between Cystic Lesions of the Pineal Gland (Descartes' Seat of the Soul) and the Pituitary (the Master Gland). J Neurol Surg B Skull Base 2021; 83:e598-e602. [DOI: 10.1055/s-0041-1735635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 08/11/2021] [Indexed: 10/20/2022] Open
Abstract
Abstract
Introduction Rene Descartes (1596–1650), the famous philosopher and scientist, identified the pineal gland as the only cerebral structure not represented bilaterally, the “seat of the soul”; and the source of rational thought. Pineal cysts (PCs) are often incidentally identified in MRI studies, with a reported prevalence of 1 to 4.3%. Rathke cleft cysts (RCCs) are pituitary lesions accounting for <1% of intracranial masses. There are scant data in the literature addressing any association between these two midline cystic lesions.
Methods We reviewed the medical records of patients presenting at our institution from April 2008 through February 2020, whose records indicated a diagnosis of RCC, and those whose records included pineal lesions. Our objective was to evaluate the association between these two midline lesions. Brain MRI studies were reviewed for the presence of PCs; only patients with PCs that measured ≥5 mm in diameter were included.
Results We identified 116 patients with RCCs, and 34 patients with PCs, treated from April 2008 through February 2020. Among the RCC group, 14/116 patients (12%) had PCs. Among the PC group, 3/34 patients (8.8%) had RCCs. Overall, 17 patients (11.3%) had concomitant RCCs and PCs. The mean maximal diameter of the PCs was 7.5 mm (range = 5–17 mm), whereas the mean maximal diameter of RCCs was 13 mm (range = 5–40 mm).
Conclusion The incidental diagnosis of cystic lesions of the pineal and pituitary gland is increasingly reported, primarily because of advances in current diagnostic modalities. Our data demonstrated no clear consensual association between pineal and pituitary cysts.
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Affiliation(s)
- Alaa S. Montaser
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Elise Y. Cho
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Michael P. Catalino
- Department of Neurosurgery, University of North Carolina, Chapel Hill, North Carolina, United States
| | - Jack Hanna
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Timothy R. Smith
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Edward R. Laws
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
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18
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Arkar U, Kučan R, Perković Benedik M, Hostnik T, Vipotnik Vesnaver T, Loboda T, Bošnjak R, Osredkar D. Clinical and Radiological Characteristics of Non-Benign Pineal Cyst Lesions in Children. Front Neurol 2021; 12:722696. [PMID: 34512533 PMCID: PMC8430827 DOI: 10.3389/fneur.2021.722696] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 07/26/2021] [Indexed: 11/13/2022] Open
Abstract
Background: With the increasing availability and advances in brain imaging, pineal cyst lesions (PCL) are becoming a common finding in the pediatric population. In the absence of evidence-based guidelines, optimal diagnostic and therapeutic approaches have not been established, and there is a risk of under- or overtreatment of these patients. Objectives: The aim of our study was to evaluate the clinical presentation and radiological features of PCL in a cohort of pediatric patients and to identify clinical parameters more commonly associated with neoplasms in the pineal region. In addition, the prevalence of PCL in the pediatric population of Slovenia was estimated. Methods: In this observational, cohort study, children treated at University Children's Hospital, Ljubljana, Slovenia in the period 1997–2016 were included if PCL was found on brain imaging. We analyzed indications for referral to a neurologist, clinical signs and symptoms, radiological features, treatment and outcome. Results: The cohort consisted of 143 children with PCL. Pineocytoma was suspected in 31 children (21.7%). Six children underwent surgery – pineocytoma was confirmed in two cases and germinoma in one (2/3 of these children had signs of increased intracranial pressure (ICP), while PCL was benign in the remaining 4 cases. Only 2 PCL enlarged during the study period, both <2mm, none of these children developed neoplasm. Two children had PCL >20mm in diameter; both showed signs of increased ICP, one patient was found to have a germinoma of the pineal region, while the other had no neoplasm. Conclusions: Most PCL do not change their features during radiological follow-up and even atypical PCL are very rarely associated with a malignant neoplasm of the pineal region. A PCL larger than 20 mm and signs of increased ICP were identified as potential markers for selecting patients at risk.
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Affiliation(s)
- Ula Arkar
- Department of Pediatric Neurology, University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Rok Kučan
- Department of Pediatric Neurology, University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Mirjana Perković Benedik
- Department of Pediatric Neurology, University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Tadeja Hostnik
- Department of Pediatric Neurology, University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | | | - Tanja Loboda
- Department of Pediatric Neurology, University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Roman Bošnjak
- Department of Neurosurgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Damjan Osredkar
- Department of Pediatric Neurology, University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Faculty of Medicine, Center for Developmental Neuroscience, University of Ljubljana, Ljubljana, Slovenia
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Abstract
With increasing use of intracranial imaging, the diagnosis of benign intracranial cysts is becoming more frequent in the pediatric population. These lesions are usually incidentally discovered during the work-up of unrelated symptoms. Most do not require treatment and many do not even require imaging follow-up. When symptomatic, symptoms of these lesions are usually caused by local mass effect. Symptomatic lesions warrant neurosurgical evaluation, and may require surgical intervention in rare, well-selected cases. This article describes three common benign intracranial cysts found in the pediatric population: arachnoid cysts, choroid cysts, and pineal cysts.
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Affiliation(s)
- Whitney E Muhlestein
- Department of Neurosurgery, University of Michigan, 1500 East Medical Center Drive, SPC 5337, Ann Arbor, MI 48109, USA
| | - Cormac O Maher
- Department of Neurosurgery, University of Michigan, 1500 East Medical Center Drive, SPC 5337, Ann Arbor, MI 48109, USA.
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Mizobuchi Y, Shimada A, Nakajima K, Kagusa H, Takagi Y. Reversible Hearing Impairment Due to Inferior Colliculi Compression by a Pineal Glial Cyst. NMC Case Rep J 2021; 8:79-84. [PMID: 34012754 PMCID: PMC8116931 DOI: 10.2176/nmccrj.cr.2020-0123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 05/25/2020] [Indexed: 11/20/2022] Open
Abstract
Pineal glial cysts associated with bilateral hearing impairment are very rare. Here, we present the case of a 13-year-old boy with a pineal cyst, which caused severe bilateral hearing impairment persisting from 6 years of age. When the patient was 6 years old, the bilateral hearing acuity was about 40 dB on audiometry. Upon admission to our otolaryngology department, his audiogram revealed a bilateral worsening of the hearing acuity (80 dB). Magnetic resonance imaging (MRI) revealed an abnormal pineal cyst with tectal compression from the left with hardly normal bilateral brainstem auditory evoked potentials (BAEPs). We obtained informed consent for exploratory surgery and employed the right occipital transtentorial approach for pineal cyst removal. Based on histological examination, we diagnosed a glial cyst of the pineal gland. At 12 months postoperatively, the patient's hearing improved, showing a bilateral hearing acuity of 40 dB on audiometry. Since the auditory pathway has both crossed and uncrossed fibers at the upper pons and midbrain level, compression at the lateral lemniscus or inferior colliculus level can cause bilateral hearing impairment. In the present case, there was a possible slow pineal cyst growth that eventually compressed the upper pons to the midbrain, lateral lemniscuses, or inferior colliculi from the left side, this eventually led to bilateral hearing impairment. These findings indicate that surgery can improve hearing acuity in patients with a pineal cyst associated with progressive hearing impairment.
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Affiliation(s)
- Yoshifumi Mizobuchi
- Department of Neurosurgery, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Tokushima, Japan
| | - Aki Shimada
- Department of Otolaryngology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Tokushima, Japan
| | - Kohei Nakajima
- Department of Neurosurgery, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Tokushima, Japan
| | - Hiroshi Kagusa
- Department of Neurosurgery, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Tokushima, Japan
| | - Yasushi Takagi
- Department of Neurosurgery, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Tokushima, Japan
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Tanaka T, Arnold L, Gabriela Mazuru D, Golzy M, Carr SB, Litofsky NS. Pineal cysts: Does anyone need long-term follow up? J Clin Neurosci 2020; 83:146-151. [PMID: 33272885 DOI: 10.1016/j.jocn.2020.10.051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 09/21/2020] [Accepted: 10/18/2020] [Indexed: 11/26/2022]
Abstract
Pineal cysts are a common incidental finding on brain magnetic resonance imaging (MRI) whichfrequently prompts referral to neurosurgery. Currently, a management algorithm for patientswithout hydrocephalus, Parinaud's syndrome, or pineal apoplexy is lacking.We aimed to identifypredictive factors of pineal cyst volume change andsurgical intervention by performing retrospective chart review of 98 patients between 2005 and 2018 diagnosed with pineal cysts gleaned from our Neurosurgery clinical databases.We included patients whose initial and follow-up MRIs were available in our institutional radiology system or whose surgical pathology confirmed pineal cyst after evaluation with an initial MRI. Patients' medical records were queried for presenting symptoms, demographic, management, and pineal cyst measurements. Three dimensions (anterior-posterior, rostral-caudal, transverse) of pineal cyst size were measured and converted to cyst volume (cm3) for analysis. Fifty-five patients (mean age 26.09 ± 14.7 years) with pineal cysts met study criteria. Follow-up ranged from 4 months to 10 years. The indications for MR imaging included headache (81.8%) and vision problems (42%).Forty-eight patients who were observed had a mean volume change of 0.051 ± 0.862 cm [3] and median volume change of 0 cm [3] Patient symptoms, referral source, and age were not associated with changes in volume on follow-up. Aggregated number of symptoms did not differ between operative and observation patients. (p = 0.29). Pineal cyst volumes tend to remain stable over serial MR images, do not reliably correlate with symptoms, and do not typically require long-term follow-up.
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Affiliation(s)
- Tomoko Tanaka
- Department of Neurosurgery, University of Arkansas for Medical Science, United States; Division of Pediatric Neurosurgery, Arkansas Children's Hospital Medical Center, United States; Division of Division of Neurosurgery, University of Missouri, School of Medicine, United States.
| | - Lauren Arnold
- University of Missouri, School of Medicine, United States
| | - Dana Gabriela Mazuru
- Department of Radiology, University of Missouri, School of Medicine, United States
| | - Mojgan Golzy
- Department of Health Management and Informatics, University of Missouri, School of Medicine, United States
| | - Steven B Carr
- Division of Division of Neurosurgery, University of Missouri, School of Medicine, United States
| | - N Scott Litofsky
- Division of Division of Neurosurgery, University of Missouri, School of Medicine, United States
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22
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Özcabi B, Akay G, Yesil G, Uyur Yalcin E, Kirmizibekmez H. A CASE OF SOTOS SYNDROME CAUSED BY A NOVEL VARIANT IN THE NSD1 GENE: A PROPOSED RATIONALE TO TREAT ACCOMPANYING PRECOCIOUS PUBERTY. ACTA ENDOCRINOLOGICA-BUCHAREST 2020; 16:245-249. [PMID: 33029244 DOI: 10.4183/aeb.2020.245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Sotos syndrome is characterized by overgrowth, macrocephaly, distinctive facial features, and learning disabilities and is associated with alterations in the nuclear receptor binding SET domain protein 1 (NSD1) gene. Due to the advanced bone age, the eventual adult height is usually at the upper limit of normal. In this case report, a 6-year and 10-month old boy who presented with Sotos syndrome was described. He also had increased testicular volumes with advanced bone age. The stimulated levels of gonadotropins revealed central precocious puberty and brain magnetic resonance imaging (MRI) showed a pineal cyst. A heterozygous duplication variant [NM_022455.4:c.4560dup; p.(His1521Thrfs*9)] in the NSD1 was identified. Triptorelin acetate treatment was started. The aim was to report the novel duplication variant in the NSD-1 in a patient with Sotos syndrome accompanied by a pineal cyst and central precocious puberty, and also to discuss the rationale for treating precocious puberty.
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Affiliation(s)
- B Özcabi
- Health Science University Zeynep Kamil Maternity and Children's Diseases Training and Research Hospital - Division of Pediatric Endocrinology, Istanbul, Turkey
| | - G Akay
- Health Science University Zeynep Kamil Maternity and Children's Diseases Training and Research Hospital - Division of Pediatric Genetics, Istanbul, Turkey
| | - G Yesil
- Health Science University Zeynep Kamil Maternity and Children's Diseases Training and Research Hospital - Bezmialem Vakif University School of Medicine - Department of Medical Genetics, Istanbul, Turkey
| | - E Uyur Yalcin
- Health Science University Zeynep Kamil Maternity and Children's Diseases Training and Research Hospital - Division of Pediatric Neurology, Istanbul, Turkey
| | - H Kirmizibekmez
- Health Science University Zeynep Kamil Maternity and Children's Diseases Training and Research Hospital - University of Health Sciences, Umraniye Research and Training Hospital - Department of Pediatrics, Division of Pediatric Endocrinology, Istanbul, Turkey
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23
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Goehner D, Soyland D, Vuong S, Trumble E. Pineal Cyst Apoplexy in an 8-Year-Old Girl: Case Report and Literature Review. World Neurosurg 2020; 142:159-166. [PMID: 32615292 DOI: 10.1016/j.wneu.2020.06.199] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 06/23/2020] [Accepted: 06/24/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Pineal cysts are common, typically asymptomatic, and are usually found incidentally in adults. In rare cases, pineal cyst apoplexy occurs as a result of an acute cystic hemorrhage. This situation can result in acute onset of severe headaches, acute obstructive hydrocephalus, mass effect on the midbrain, and even death. Pineal apoplexy is most common in women of reproductive age, whereas pediatric cases continue to be less prevalent. Pineal cyst apoplexy remains a rare entity with ≥30 cases presented in the literature to date. CASE DESCRIPTION We present the youngest case in the literature (an 8-year-old girl with a pineal cyst that resulted in apoplexy), her diagnostic workup, management, and follow-up. We supplement our case study with a literature review of pineal cyst apoplexy. CONCLUSIONS Pineal cyst apoplexy remains a rare clinical event in the pediatric population. Our case details the diagnosis and management of an 8-year-old girl with pineal cyst apoplexy. We also discuss our findings from our literature search for all reported cases of pineal cyst apoplexy.
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Affiliation(s)
- Dylan Goehner
- Division of Neurosurgery, Sanford School of Medicine, University of South Dakota, Sioux Falls, South Dakota, USA.
| | - Dallas Soyland
- Division of Neurosurgery, Sanford School of Medicine, University of South Dakota, Sioux Falls, South Dakota, USA
| | - Shawn Vuong
- Division of Neurosurgery, Sanford School of Medicine, University of South Dakota, Sioux Falls, South Dakota, USA
| | - Eric Trumble
- Division of Neurosurgery, Sanford School of Medicine, University of South Dakota, Sioux Falls, South Dakota, USA
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24
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Choque-Velasquez J, Colasanti R, Baluszek S, Resendiz-Nieves J, Muhammad S, Ludtka C, Hernesniemi J. Systematic review of pineal cysts surgery in pediatric patients. Childs Nerv Syst 2020; 36:2927-2938. [PMID: 32691194 PMCID: PMC7649165 DOI: 10.1007/s00381-020-04792-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 07/03/2020] [Indexed: 01/26/2023]
Abstract
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.
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Affiliation(s)
- Joham Choque-Velasquez
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital Helsinki, Helsinki, Finland. .,Juha Hernesniemi International Center for Neurosurgery, Henan Provincial People's Hospital, Zhengzhou, China.
| | - Roberto Colasanti
- Department of Neurosurgery, Umberto I General Hospital, Università Politecnica delle Marche, Ancona, Italy ,Department of Neurosurgery, Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Szymon Baluszek
- Laboratory of Molecular Neurobiology, Nencki Institute of Experimental Biology, Warsaw, Poland ,Clinical Department of Neurosurgery, Central Clinical Hospital Ministry of Interior, Warsaw, Poland
| | - Julio Resendiz-Nieves
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital Helsinki, Helsinki, Finland
| | - Sajjad Muhammad
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital Helsinki, Helsinki, Finland ,Department of Neurosurgery, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Christopher Ludtka
- Department of Biomedical Engineering, University of Florida, Florida, USA
| | - Juha Hernesniemi
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital Helsinki, Helsinki, Finland ,Juha Hernesniemi International Center for Neurosurgery, Henan Provincial People’s Hospital, Zhengzhou, China
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25
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Pineal Cyst without Hydrocephalus: Clinical Presentation and Postoperative Clinical Course After Infratentorial Supracerebellar Resection. World Neurosurg 2019; 129:e530-e537. [DOI: 10.1016/j.wneu.2019.05.200] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 05/22/2019] [Accepted: 05/23/2019] [Indexed: 11/24/2022]
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26
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Yoon JS, So CH, Lee HS, Lim JS, Hwang JS. Prevalence of Pathological Brain Lesions in Girls with Central Precocious Puberty: Possible Overestimation? J Korean Med Sci 2018; 33:e329. [PMID: 30546283 PMCID: PMC6291406 DOI: 10.3346/jkms.2018.33.e329] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 09/20/2018] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Brain magnetic resonance imaging (MRI) is routinely performed to identify brain lesions in girls with central precocious puberty (CPP). We aimed to investigate the prevalence and type of brain lesions among Korean girls with CPP and evaluate the need for routine brain MRI examinations. METHODS This retrospective cross-sectional study evaluated data on 3,528 girls diagnosed with CPP from April 2003 to December 2016, and identified 317 girls who underwent sellar MRI. Exclusion criteria were patients with a known brain tumor or who did not undergo brain MRI due to refusal or the decision of the pediatric endocrinologist. RESULTS Normal sellar MRI findings were observed in 291 of the 317 girls (91.8%). Incidental findings were observed in 26 girls (8.2%). None of the patients had pathological brain lesions. CONCLUSION The prevalence of intracranial lesions among girls who were generally healthy and without neurological symptoms but diagnosed with CPP was lower than that previously reported. Furthermore, none of the identified lesions required treatment. It may be prudent to reconsider the routine use of brain MRI to screen all patients with CPP, especially if they are healthy and neurologically asymptomatic, and are girls aged 6-8 years.
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Affiliation(s)
- Jong Seo Yoon
- Department of Pediatrics, Ajou University School of Medicine, Ajou University Hospital, Suwon, Korea
| | - Cheol Hwan So
- Department of Pediatrics, Wonkwang University School of Medicine, Wonkwang University Hospital, Iksan, Korea
| | - Hae Sang Lee
- Department of Pediatrics, Ajou University School of Medicine, Ajou University Hospital, Suwon, Korea
| | - Jung Sub Lim
- Department of Pediatrics, Korea Cancer Center Hospital, Seoul, Korea
| | - Jin Soon Hwang
- Department of Pediatrics, Ajou University School of Medicine, Ajou University Hospital, Suwon, Korea
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27
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Pitskhelauri DI, Konovalov AN, Abramov IT, Danilov GV, Pronin IN, Alexandrova EV, Serova NK, Sanikidze AZ. Pineal Cyst-Related Aqueductal Stenosis as Cause of Intractable Headaches in Nonhydrocephalic Patients. World Neurosurg 2018; 123:e147-e155. [PMID: 30468924 DOI: 10.1016/j.wneu.2018.11.096] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 11/10/2018] [Accepted: 11/12/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Pineal cysts (PCs) are histologically benign lesions of the pineal gland. Although the majority of PCs are asymptomatic, some cases are ambiguous and accompanied by nonspecific symptoms of variable severity. We suggested that disabling headache in nonhydrocephalic patients with PCs is associated with cerebral aqueduct (CAq) stenosis. METHODS A retrospective analysis was conducted in patients with PCs suffering from headache without secondary hydrocephalus who underwent surgical resection at Burdenko Neurosurgery Center between 1995 and 2016. All available medical records and radiographic images were retrospectively assessed in these patients. The comparison groups included 22 patients with nonoperated PCs and 25 healthy individuals. Specific magnetic resonance imaging measures were selected to assess the morphometry of the CAq and degree of the stenosis. RESULTS In 25 patients (82%) we observed clinical improvement after surgery in a follow-up period. Among those with improvement, 10 of them (40%) experienced total relief and 15 of them (60%) had marked headache diminishment. In 5 patients the headache remained persistent. The preoperative rostral CAq diameter appeared to be significantly narrower (P = 0.0011045), and the preoperative rostral/caudal diameter ratio (Rd/Cd) was found to be lower (P = 0.004391) in patients who recovered from headache versus those who did not. CONCLUSION The results indicate a statistically significant relationship between the changes in the CAq morphometrics and the clinical outcome in postoperative period. Surgical removal of symptomatic pineal cysts in patients without hydrocephalus can be considered as an effective treatment. However, a thorough preoperative examination and patient selection should be conducted in every case.
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Affiliation(s)
- David I Pitskhelauri
- Department of Neurooncology, Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia
| | - Alexander N Konovalov
- Department of Neurooncology, Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia
| | - Irakliy T Abramov
- Department of Neurooncology, Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia.
| | - Gleb V Danilov
- Department of Neurooncology, Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia
| | - Igor N Pronin
- Department of Neuroradiology, Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia
| | - Evgeniya V Alexandrova
- Department of Neurology, Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia
| | - Nataliya K Serova
- Department of Neuroopththalmology, Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia
| | - Alexander Z Sanikidze
- Department of Neurooncology, Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia
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28
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Sex Difference in the Morphology of Pineal Gland in Adults Based on Brain Magnetic Resonance Imaging. J Craniofac Surg 2018; 29:e509-e513. [PMID: 29608478 DOI: 10.1097/scs.0000000000004558] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE We aimed to figure out the anatomical features of pineal gland region on magnetic resonance imaging (MRI) and to explore the sex difference in pineal gland-related parameters with increasing age. METHODS We measured the pineal gland on MRI images from 198 healthy adults (96 males and 102 females). Included subjects were divided into 4 age groups. After 3-dimensional reconstruction, the anatomic features of pineal gland and its distances to superior colliculus and splenium of corpus callosum were analyzed in each group. The prevalence of cystic pineal gland was calculated. Moreover, we calculated the volume of pineal gland (PGV) and explored the differences of PGV in males and females across different age groups. Linear regression analysis was performed to detect the relationship between age and pineal gland-related parameters. RESULTS In 198 subjects, the mean length, width, and height of pineal gland were 7.58 ± 0.45 mm, 4.92 ± 0.40 mm, and 2.90 ± 0.20 mm. The distances between pineal gland and superior colliculus as well as splenium of corpus callosum were 3.96 ± 0.92 mm and 4.3 ± 1.89 mm, respectively. The PGV was 54.1 ± 7.02 mm. Significant sex differences were found in pineal gland length (P < 0.001), cranial cavity diameter (P < 0.001), pineal gland index (P < 0.001) and PGV values (P = 0.02). The prevalence of cystic pineal gland was 36.4% in total subjects, 41.7% in males and 32.4% in females. No linear relationship was found between age and pineal gland parameters. CONCLUSION We measured the pineal gland morphology based on MRI images. Significant influences on pineal gland parameters were found in subjects with different sex, whereas no effect was observed from age.
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29
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Gokce E, Beyhan M. Evaluation of pineal cysts with magnetic resonance imaging. World J Radiol 2018; 10:65-77. [PMID: 30079153 PMCID: PMC6068724 DOI: 10.4329/wjr.v10.i7.65] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 04/29/2018] [Accepted: 05/23/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate radiological imaging findings of patients who had been found to have pineal cyst (PC) in brain magnetic resonance imaging (MRI).
METHODS A total of 9546 patients who had brain MRI examination in March 2010-January 2018 period were studied. Fifty-six patients (44 female and 12 male) found to have PC were evaluated. Eighteen of the patients had had follow-up examinations of 2-94 mo (mean 30.50 ± 28.83). PC dimensions and volume, radiological imaging features (signal intensities, contours, internal septation-loculation and contrast-enhancement features) and natural history in cases who had been followed-up were evaluated by two radiologists.
RESULTS Of 9546 patients, 5555 were female (58.2%) and 3991 male (41.8%). Age range was 1-99 (mean 43.18 ± 20.94). PC frequency was calculated to be 0.58%. Forty-four of the 56 patients (78.57%) with PC were female and 12 male (21.43%), and their age range was 5-61 (mean 31.26 ± 12.73). Thirty-five of the PCs were typical (62.50%) and 21 (37.50%) were atypical. No significant difference was found between initial and final imaging sizes of PCs which were monitored by follow-up examinations (P > 0.05).
CONCLUSION PCs are cysts which do not show clear size and natural changes and are more frequently observed in females and in adult ages. Most of them are isointense with cerebrospinal fluid on T1 and T2A weighted images, hyperintense compared to cerebrospinal fluid on fluid-attenuated inversion recovery; sequence and smoothly contoured. Their typical forms have peripheral rim and multilocular ones may have septal contrast-enhancement.
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Affiliation(s)
- Erkan Gokce
- Department of Radiology, Gaziosmanpaşa University, School of Medicine, Tokat 60100, Turkey
| | - Murat Beyhan
- Department of Radiology, Tokat State Hospital, Tokat 60100, Turkey
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30
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The prevalence of brain abnormalities in boys with central precocious puberty may be overestimated. PLoS One 2018; 13:e0195209. [PMID: 29614125 PMCID: PMC5882100 DOI: 10.1371/journal.pone.0195209] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 03/19/2018] [Indexed: 01/15/2023] Open
Abstract
Brain magnetic resonance imaging (MRI) is routinely performed to identify brain lesions in boys with central precocious puberty (CPP). We investigated the prevalence of CPP in Korean boys and the necessity for routine brain MRI examinations. This retrospective cross-sectional study was conducted from April 2003 to December 2016 at a Korean university hospital. Among 151 boys who were diagnosed with CPP, the data of 138 boys who underwent sellar MRI were evaluated. The mean age of the study subjects was 9.51 ± 0.56 years (<8 years [n = 4] and ≥8 years [n = 134]). We excluded patients who had been previously diagnosed with brain tumors and those who did not undergo a sellar MRI because of refusal or the decision of the pediatric endocrinologist. The main outcome measure was the prevalence of intracranial lesions among boys with CPP. Normal sellar MRI findings were observed in 128 of the 138 boys (93%). Mild brain abnormalities were found in 10 boys (7%), while none of the patients had pathological brain lesions. The prevalence (7%) of intracranial lesions among boys who were healthy, did not have neurological symptoms, and were diagnosed with CPP was different from that previously reported. None of the identified lesions necessitated treatment. Although this was a single country study, we found that the previously reported prevalence of brain lesions in boys with CPP is much higher than the prevalence observed in Korea. This study suggests the need to globally reevaluate the prevalence of pathological brain lesions among male pediatric patients with CPP.
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31
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Ophthalmological symptoms in children with intracranial cysts. Sci Rep 2017; 7:13630. [PMID: 29051539 PMCID: PMC5648882 DOI: 10.1038/s41598-017-13266-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 09/19/2017] [Indexed: 11/08/2022] Open
Abstract
The purpose of this study was to perform an ophthalmological assessment in children with intracranial cysts and to assess the correlation between the occurrence of cysts and visual disorders. The documentation of 46 children with intracranial cysts, monitored by the Children’s Outpatient Ophthalmology Clinic, Poznan, Poland was analysed. The best corrected visual acuity (BCVA), the alignment of the eyes, visual evoked potentials (VEP), comprehensive eye examination were performed in all patients. Additional ophthalmological tests were conducted to eliminate other causes of decreased visual acuity.Included in the final analysis were 26 children (52 eyes). The average age at the last visit was 10.3 years. Sixteen children (61.5%) had arachnoid cysts located in the posterior cranial fossa, 3 children (11.5%) in the middle cranial fossa, while 7 children (27%) had a pineal cyst. Decreased BCVA was found in 13 children, abnormal VEP in 13, strabismus in 14 patients (53.9%), nystagmus in 5 patients (19.2%), and double vision in 2 patients (7.7%). Numerous visual disorders in children with intracranial cysts suggest the necessity to carry out enhanced ophthalmological diagnostics in these patients. In the examined patient group, visual disorders occurred mostly in the case of arachnoid cysts of the posterior fossa.
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32
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Jussila MP, Olsén P, Salokorpi N, Suo-Palosaari M. Follow-up of pineal cysts in children: is it necessary? Neuroradiology 2017; 59:1265-1273. [PMID: 28942520 DOI: 10.1007/s00234-017-1926-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 09/12/2017] [Indexed: 12/19/2022]
Abstract
PURPOSE Pineal cysts are common incidental findings in children undergoing magnetic resonance imaging (MRI). Several studies have suggested MRI follow-up if the cyst is larger than 10 mm. However, cysts do not usually change during follow-up. Prevalence, growth, and structure of the pineal cysts were analyzed to decide if follow-up MRI is necessary. METHODS A retrospective review between 2010 and 2015 was performed using 3851 MRI examinations of children aged 0-16 years to detect pineal cysts having a maximum diameter ≥ 10 mm. Eighty-one children with pineal cysts were identified and 79 of them had been controlled by MRI. Cysts were analyzed for the size, growth, and structure. RESULTS A total of 1.8% of the children had a pineal cyst with a diameter ≥ 10 mm. Cysts were present in 48 girls (59.3%) and 33 boys (40.7%). Most pineal cysts (70/79) did not significantly grow during the follow-up (median 10 months, range 3-145 months). A total of 11.4% (9/79) of the cysts grew with the biggest change measured from the outer cyst wall sagittal anteroposterior dimension (mean 3.4 mm ± 1.7 mm). Only one cyst grew more than 5 mm. We found no factors correlating with the cyst growth among 9 cysts that grew > 2 mm. CONCLUSIONS A majority of pineal cysts remained unchanged during the MRI follow-up. Results of this study suggest that routine MRI follow-up of pineal cysts is not necessary in the absence of unusual radiological characteristics or related clinical symptoms.
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Affiliation(s)
- Miro-Pekka Jussila
- Department of Diagnostic Radiology, Oulu University Hospital and University of Oulu, P.O. Box 50, OYS, Oulu, 90029, Finland
- Department of Children and Adolescents, Oulu University Hospital and University of Oulu, P.O. Box 23, OYS, Oulu, 90029, Finland
| | - Päivi Olsén
- Department of Children and Adolescents, Oulu University Hospital and University of Oulu, P.O. Box 23, OYS, Oulu, 90029, Finland
- PEDEGO Research Group, Medical Research Center, University of Oulu, Oulu, Finland
| | - Niina Salokorpi
- Department of Neurosurgery, Oulu University Hospital and University of Oulu, P.O. Box 21, OYS, Oulu, 90029, Finland
- Medical Research Center, University of Oulu, Oulu, Finland
| | - Maria Suo-Palosaari
- Department of Diagnostic Radiology, Oulu University Hospital and University of Oulu, P.O. Box 50, OYS, Oulu, 90029, Finland.
- Medical Research Center, University of Oulu, Oulu, Finland.
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33
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Bonow RH, Friedman SD, Perez FA, Ellenbogen RG, Browd SR, Mac Donald CL, Vavilala MS, Rivara FP. Prevalence of Abnormal Magnetic Resonance Imaging Findings in Children with Persistent Symptoms after Pediatric Sports-Related Concussion. J Neurotrauma 2017; 34:2706-2712. [PMID: 28490224 DOI: 10.1089/neu.2017.4970] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
A subset of patients experience persistent symptoms after pediatric concussion, and magnetic resonance imaging (MRI) is commonly used to evaluate for pathology. The utility of this practice is unclear. We conducted a retrospective cohort study to describe the MRI findings in children with concussion. A registry of all patients seen at our institution from January 2010 through March 2016 with pediatric sports-related concussion was cross-referenced with a database of radiographical studies. Radiology reports were reviewed for abnormal findings. Patients with abnormal computed tomographies or MRI scans ordered for reasons other than concussion were excluded. Among 3338 children identified with concussion, 427 underwent MRI. Only 2 (0.5%) had findings compatible with traumatic injury, consisting in both of microhemorrhage. Sixty-one patients (14.3%) had abnormal findings unrelated to trauma, including 24 nonspecific T2 changes, 15 pineal cysts, eight Chiari I malformations, and five arachnoid cysts. One child underwent craniotomy for a cerebellar hemangioblastoma after presenting with ataxia; another had cortical dysplasia resected after seizure. The 2 patients with microhemorrhage each had three previous concussions, significantly more than patients whose scans were normal (median, 1) or abnormal without injury (median, 1.5; p = 0.048). MRI rarely revealed intracranial injuries in children post-concussion, and the clinical relevance of these uncommon findings remains unclear. Abnormalities unrelated to trauma are usually benign. However, MRI should be thoughtfully considered in children who present with concerning or atypical symptoms.
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Affiliation(s)
- Robert H Bonow
- 1 Harborview Injury Prevention Research Center, Harborview Medical Center, University of Washington , Seattle, Washington.,2 Department of Neurological Surgery, University of Washington , and Seattle Children's Hospital, Seattle, Washington
| | - Seth D Friedman
- 3 Radiology Clinical Research Imaging Core, Center for Clinical and Translational Research , Seattle Children's Hospital, Seattle, Washington
| | - Francisco A Perez
- 4 Department of Radiology, Seattle Children's Hospital, University of Washington , and Seattle Children's Hospital, Seattle, Washington
| | - Richard G Ellenbogen
- 2 Department of Neurological Surgery, University of Washington , and Seattle Children's Hospital, Seattle, Washington
| | - Samuel R Browd
- 2 Department of Neurological Surgery, University of Washington , and Seattle Children's Hospital, Seattle, Washington
| | - Christine L Mac Donald
- 2 Department of Neurological Surgery, University of Washington , and Seattle Children's Hospital, Seattle, Washington
| | - Monica S Vavilala
- 1 Harborview Injury Prevention Research Center, Harborview Medical Center, University of Washington , Seattle, Washington.,5 Department of Anesthesia & Pain Medicine, Harborview Medical Center, University of Washington , Seattle, Washington
| | - Frederick P Rivara
- 1 Harborview Injury Prevention Research Center, Harborview Medical Center, University of Washington , Seattle, Washington.,6 Department of Pediatrics, Seattle Children's Hospital, University of Washington , and Seattle Children's Hospital, Seattle, Washington
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Eide PK, Ringstad G. Results of surgery in symptomatic non-hydrocephalic pineal cysts: role of magnetic resonance imaging biomarkers indicative of central venous hypertension. Acta Neurochir (Wien) 2017; 159:349-361. [PMID: 27878615 DOI: 10.1007/s00701-016-3029-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 11/09/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND We have previously proposed that pineal cysts (PCs) may result in crowding of the pineal recess, causing symptoms due to compression of the internal cerebral veins and central venous hypertension. In the present study, we compared clinical outcome of different treatment modalities in symptomatic individuals with non-hydrocephalic PCs. METHODS The study included all patients managed surgically for non-hydrocephalic PCs in our Department of Neurosurgery over a 10-year period. We applied a questionnaire to determine occurrence of symptoms before and after surgery, which allowed the use of a grading scale for symptom severity. Magnetic resonance imaging (MRI) biomarkers indicative of central venous hypertension were assessed before and after surgery. RESULTS Relief of symptoms after surgery was most efficiently obtained by complete microsurgical cyst removal [n = 15; no (0/15), some (1/15) or marked (14/15) improvement], and to a lesser extent by microsurgical cyst fenestration [n = 6; no (2/6), some (4/6) or marked (0/6) improvement]. Shunt surgery was not successful [n = 6; no (5/6), some (1/6) or marked (0/6) improvement]. In all patients, the proposed MRI biomarkers gave evidence of central venous hypertension (PC grades 2-4). CONCLUSIONS Microsurgical cyst removal provided marked symptom relief in symptomatic individuals with non-hydrocephalic PCs and MRI biomarkers of central venous hypertension. The hypothesis that PC-induced crowding of the pineal recess may compromise venous run-off and induce a central venous hypertension syndrome deserves further study.
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Affiliation(s)
- Per Kristian Eide
- Department of Neurosurgery, Oslo University Hospital-Rikshospitalet, Postboks 4950, Nydalen, 0424, Oslo, Norway.
- Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Geir Ringstad
- Department of Radiology and Nuclear Medicine, Oslo University Hospital- Rikshospitalet, Oslo, Norway
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Abramov IT, Pitskhelauri DI, Serova NK. [Pineal cyst]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2017; 81:113-120. [PMID: 28914878 DOI: 10.17116/neiro2017814113-120] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
UNLABELLED A pineal cyst (PC) is a benign neoplasm in the pineal region, or more precisely in the pineal body. Most cysts are incidental findings and are not associated with symptoms typical of patients seeking medical advice. Symptomatic cysts are discovered less often and, depending on the clinical picture, require different treatment approaches. MATERIAL AND METHODS We analyzed the literature data about the clinical picture, diagnosis, and treatment of PCs for more than a century (1914-2016). CONCLUSION To date, there is no single approach for managing PC patients. The indications for surgical treatment of symptomatic PCs are still not fully defined. It remains unclear which PC cases should be followed-up, and how often control examinations should be performed. More research of PCs is needed to develop new approaches to treatment of PC patients.
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Affiliation(s)
- I T Abramov
- Burdenko Neurosurgical Institute, Moscow, Russia
| | | | - N K Serova
- Burdenko Neurosurgical Institute, Moscow, Russia
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Starke RM, Cappuzzo JM, Erickson NJ, Sherman JH. Pineal cysts and other pineal region malignancies: determining factors predictive of hydrocephalus and malignancy. J Neurosurg 2016; 127:249-254. [PMID: 27767399 DOI: 10.3171/2016.8.jns16220] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Cystic lesions of the pineal gland are most often uncomplicated benign lesions with typical MRI characteristics. The authors aimed to study pineal lesion characteristics on MRI to better distinguish benign pineal cysts from other pineal region malignancies as well as to determine which characteristics were predictive of the latter malignancies. They also aimed to study risk factors predictive of hydrocephalus or malignancy in patients harboring these lesions. METHODS The authors performed a retrospective review of a prospectively compiled database documenting the outcomes of patients with suspected pineal cysts on MRI who had presented in the period from 1998 to 2004. Inherent patient and lesion characteristics were assessed in a univariate logistic regression analysis to predict the following dependent variables: development of hydrocephalus, biopsy-confirmed malignancy, and intervention. Possible inherent patient and lesion characteristics included age, sex, T1 and T2 MRI signal pattern, contrast enhancement pattern, presence of cyst, presence of blood, complexity of lesion, presence of calcification, and duration of follow-up. Inherent patient and lesion characteristics that were predictive in the univariate analysis (p < 0.15) were included in the multivariable logistic regression analysis. RESULTS Of the 79 patients with benign-appearing pineal cysts, 26 (33%) were male and 53 (67%) were female, with a median age of 38 years (range 9-86 years). The median cyst radius was 5 mm (range 1-20 mm). Two patients (2.5%) had evidence of calcifications, 7 (9%) had multicystic lesions, and 25 (32%) had some evidence of contrast enhancement. The median follow-up interval was 3 years (range 0.5-13 years). Seven patients (9%) had an increase in the size of their lesion over time. Eight patients (10%) had a hemorrhage, and 11 patients (14%) developed hydrocephalus. Nine (11%) received ventriculoperitoneal shunts for the development of hydrocephalus, and 12 patients (16%) were found to have malignancies following biopsy or resection. In the multivariate analysis, contrast enhancement on MRI (OR 1.6, 95% CI 2.86-74.74, p = 0.013) and hemorrhage (OR 26.9, 95% CI 3.4-212.7, p = 0.022) were predictive of hydrocephalus. Increasing lesion size and hydrocephalus were near perfect predictors of malignancy and thus were removed from multivariate analysis. In addition, contrast enhancement on MRI (OR 8.8, 95% CI 2.0-38.6, p = 0.004) and hemorrhage (OR 6.8, 95% CI 1.1-40.5, p = 0.036) were predictive of malignancy. CONCLUSIONS Although cystic abnormalities of the pineal gland are often benign lesions, they are frequently monitored over time, as other pineal region pathologies may appear similarly on MRI. Patients with growing lesions, contrast enhancement, and hemorrhage on MRI are more likely to develop hydrocephalus and have malignant pathology on histological examination and should therefore be followed up with serial MRI with a lower threshold for neurosurgical intervention.
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Affiliation(s)
- Robert M Starke
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | | | | | - Jonathan H Sherman
- Department of Neurological Surgery, The George Washington University, Washington, DC
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Gupta AK, Jones M, Prelog K, Bui J, Zhu J, Ng A, Dalla-Pozza L. Pineal cysts-A benign association with familial retinoblastoma. Pediatr Hematol Oncol 2016; 33:408-414. [PMID: 27689687 DOI: 10.1080/08880018.2016.1225326] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Patients with familial/heritable retinoblastoma (RB) are at increased risk of developing second malignancies throughout life, including a pineoblastoma (trilateral RB [TRB]) in early childhood. Current guidelines recommend regular surveillance brain imaging for those with heritable RB until 5 years of age. The presence of pineal cysts has been reported in patients with RB. Pineal cysts are thought to arise due to focal degeneration of the pineal gland and can be found incidentally. The finding of pineal abnormalities including cysts in children with RB on imaging is disconcerting, as it raises the possibility of an underlying malignancy, specifically a pinealoblastoma. The authors reviewed the imaging findings and clinical significance of pineal cysts in 69 patients diagnosed with RB at our center between December 1999 and November 2015. Twenty-six patients had pineal cysts found on brain magnetic resonance imaging (MRI) scans performed either at diagnosis or follow-up. Thirty-eight of 69 patients had underlying heritable RB. Nineteen of 38 familial RB patients had a pineal cyst compared with 3 out of 26 with sporadic RB (P = .004). In the majority, the imaging characteristics and size of the cysts remained stable or resolved. In this cohort, pineal cysts were detected at significantly increased frequency in heritable RB. This may be a benign association or may reflect abnormal underlying biology of pineal tissue in individuals highly susceptible to malignancy. Imaging characteristics can be helpful in distinguishing between benign and malignant lesions. The presence of a pineal cyst in patients with unilateral disease may be a useful indicator of underlying heritable RB.
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Affiliation(s)
- Aditya Kumar Gupta
- a Department of Oncology , Children's Hospital at Westmead , Sydney , New South Wales , Australia
| | - Michael Jones
- b Department of Ophthalmology , Children's Hospital at Westmead , Sydney , New South Wales , Australia
| | - Kristina Prelog
- c Department of Radiology , Children's Hospital at Westmead , Sydney , New South Wales , Australia
| | - John Bui
- c Department of Radiology , Children's Hospital at Westmead , Sydney , New South Wales , Australia
| | - Jacqui Zhu
- c Department of Radiology , Children's Hospital at Westmead , Sydney , New South Wales , Australia
| | - Anthea Ng
- a Department of Oncology , Children's Hospital at Westmead , Sydney , New South Wales , Australia
| | - Luciano Dalla-Pozza
- a Department of Oncology , Children's Hospital at Westmead , Sydney , New South Wales , Australia
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Eide PK, Ringstad G. Increased pulsatile intracranial pressure in patients with symptomatic pineal cysts and magnetic resonance imaging biomarkers indicative of central venous hypertension. J Neurol Sci 2016; 367:247-55. [PMID: 27423599 DOI: 10.1016/j.jns.2016.06.028] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 05/11/2016] [Accepted: 06/10/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND In symptomatic individuals with non-hydrocephalic pineal cysts (PCs), it remains controversial what causes the symptoms. Based on magnetic resonance imaging (MRI) biomarkers, we proposed that PC-associated crowding of the pineal recess may cause central venous hypertension. The aim of this study was to compare pulsatile and static ICP in patients with PCs and chronic daily headache (CDH), and compare ICP data in PC patients with the previously identified MRI biomarkers. METHODS All patients assessed with over-night ICP monitoring for PCs or CDH who had been ruled out for idiopathic intracranial hypertension without papilledema (IIHWOP) were retrieved from the database. The symptoms as well as the pulsatile and static ICP scores were compared between the PC and CDH patients, and ICP scores were compared with the MRI biomarkers indicative of central venous hypertension. RESULTS The pulsatile ICP was significantly increased in the symptomatic patients with non-hydrocephalic PCs as compared to the CDH patients. Pulsatile ICP was significantly increased in the individuals with PC-grades 3-4, who had MRI biomarkers indicative of central venous hypertension. The tectum-splenium-cyst ratio correlated positively with pulsatile ICP and an index of thalamic edema. CONCLUSIONS Pulsatile ICP is increased in symptomatic patients with PCs and imaging evidence of central venous hypertension, supporting the hypothesis that PC-induced crowding of the pineal recess and venous obstruction may cause a central venous hypertension syndrome.
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Affiliation(s)
- Per Kristian Eide
- Dept. of Neurosurgery, Oslo University Hospital-Rikshospitalet, Oslo, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Geir Ringstad
- Dept. of Radiology and Nuclear Medicine, Oslo University Hospital- Rikshospitalet, Oslo, Norway
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MRI-based assessment of the pineal gland in a large population of children aged 0-5 years and comparison with pineoblastoma: part I, the solid gland. Neuroradiology 2016; 58:705-12. [PMID: 27130616 PMCID: PMC4958126 DOI: 10.1007/s00234-016-1684-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 03/23/2016] [Indexed: 11/14/2022]
Abstract
Introduction Differentiation between normal solid (non-cystic) pineal glands and pineal pathologies on brain MRI is difficult. The aim of this study was to assess the size of the solid pineal gland in children (0–5 years) and compare the findings with published pineoblastoma cases. Methods We retrospectively analyzed the size (width, height, planimetric area) of solid pineal glands in 184 non-retinoblastoma patients (73 female, 111 male) aged 0–5 years on MRI. The effect of age and gender on gland size was evaluated. Linear regression analysis was performed to analyze the relation between size and age. Ninety-nine percent prediction intervals around the mean were added to construct a normal size range per age, with the upper bound of the predictive interval as the parameter of interest as a cutoff for normalcy. Results There was no significant interaction of gender and age for all the three pineal gland parameters (width, height, and area). Linear regression analysis gave 99 % upper prediction bounds of 7.9, 4.8, and 25.4 mm2, respectively, for width, height, and area. The slopes (size increase per month) of each parameter were 0.046, 0.023, and 0.202, respectively. Ninety-three percent (95 % CI 66–100 %) of asymptomatic solid pineoblastomas were larger in size than the 99 % upper bound. Conclusion This study establishes norms for solid pineal gland size in non-retinoblastoma children aged 0–5 years. Knowledge of the size of the normal pineal gland is helpful for detection of pineal gland abnormalities, particularly pineoblastoma. Electronic supplementary material The online version of this article (doi:10.1007/s00234-016-1684-z) contains supplementary material, which is available to authorized users.
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Nevins EJ, Das K, Bhojak M, Pinto RS, Hoque MN, Jenkinson MD, Chavredakis E. Incidental Pineal Cysts: Is Surveillance Necessary? World Neurosurg 2016; 90:96-102. [PMID: 26944882 DOI: 10.1016/j.wneu.2016.02.092] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Revised: 02/21/2016] [Accepted: 02/22/2016] [Indexed: 01/11/2023]
Abstract
OBJECTIVE The natural history of incidental pineal cysts is poorly understood. Neurosurgeons and neuroradiologists are more frequently faced with this disease in the advent of higher-resolution magnetic resonance imaging (MRI) scanning. We aim to suggest a suitable surveillance strategy for these patients. METHODS All patients who had MRI of the brain between June 2007 and January 2014 (n = 42,099) at The Walton Centre for Neurology and Neurosurgery were included. Radiologic reports containing the terms "pineal" and "cyst" were reviewed to identify patients. RESULTS A total of 281 patients were identified with pineal cysts. The principal indication for head MRI was headache (50.2%), although no symptoms were deemed attributable to pineal disease. A total of 178 patients (63.3%) were female, and the age at diagnosis ranged from 16 to 84 years. The median size of pineal cyst at diagnosis was 10 mm. A total of 181 patients had subsequent follow-up at a median time of 6 months (range, 1-68). Eleven pineal cysts (6%) changed size during the follow-up period. Four patients had a reduction in cyst size; the median change was 2.5 mm. A further 7 pineal cysts increased in cyst size; the median change was 2 mm. No patients developed complications. CONCLUSIONS Incidental pineal cysts typically show a benign course. In the adult population, they do not require long-term neurosurgical follow-up, because pineal cysts tend to remain a stable size. In asymptomatic patients, we recommend a single follow-up MRI scan at 12 months to confirm diagnosis. The patient should then be discharged if the cyst remains stable.
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Affiliation(s)
- Edward J Nevins
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom.
| | - Kumar Das
- Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Maneesh Bhojak
- Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Rohan S Pinto
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Mohammed N Hoque
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Michael D Jenkinson
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom; Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Emmanuel Chavredakis
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
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Magnetic resonance imaging biomarkers indicate a central venous hypertension syndrome in patients with symptomatic pineal cysts. J Neurol Sci 2016; 363:207-16. [PMID: 27000252 DOI: 10.1016/j.jns.2016.02.038] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Revised: 02/15/2016] [Accepted: 02/16/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND While most pineal cysts (PCs) are asymptomatic, some PCs are accompanied with symptoms of variable severity. We suggested that symptom severity in symptomatic patients with non-hydrocephalic PCs relates to venous compression causing central venous hypertension. This study explored whether possible magnetic resonance imaging (MRI) biomarkers of central venous hypertension could differentiate the severity of symptoms in individuals with non-hydrocephalic PCs. METHODS The study included all individuals with PCs and MRI available for analysis followed conservatively within the department from 2003 to 2014. Severity of symptoms at follow-up were assessed from a questionnaire. Suggested MRI biomarkers indicative of central venous hypertension were explored, in addition to MRI measures of cyst size, aqueduct stenosis, and tectal compression. RESULTS The study included 66 patients. As compared to the 27/66 patients (41%) with "None-Moderate" symptoms at follow-up, the 39/66 patients (59%) with "Much-Severe" symptoms presented with significantly altered indices of central venous hypertension (tectum-splenium-cyst ratio and indices of thalamic and periventricular edema). PC grading based on MRI biomarkers of central venous hypertension differentiated the severity of symptoms. CONCLUSION The results indicate an association between severity of symptoms and MRI biomarkers of central venous hypertension in symptomatic individuals with non-hydrocephalic PCs.
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Pham TTH, Siebert E, Asbach P, Willerding G, Erb-Eigner K. Magnetic resonance imaging based morphologic evaluation of the pineal gland for suspected pineoblastoma in retinoblastoma patients and age-matched controls. J Neurol Sci 2015; 359:185-92. [DOI: 10.1016/j.jns.2015.10.046] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 10/21/2015] [Accepted: 10/22/2015] [Indexed: 10/22/2022]
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BÖHRNSEN FLORIAN, ENDERS CHRISTINA, LUDWIG HANSCHRISTOPH, BRÜCK WOLFGANG, FÜZESI LASZLO, GUTENBERG ANGELIKA. Common molecularcytogenetic alterations in tumors originating from the pineal region. Oncol Lett 2015; 10:1853-1857. [PMID: 26622764 PMCID: PMC4533695 DOI: 10.3892/ol.2015.3383] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2014] [Accepted: 05/07/2015] [Indexed: 12/31/2022] Open
Abstract
Tumors of the pineal region (PR) are rare and can be subdivided into four main histomorphological groups: Pineal-parenchymal tumors (PPT), germ cell tumors (GCT), glial tumors and miscellaneous tumors. The appropriate pathological classification and grading of these malignancies is essential for determining the clinical management and prognosis. However, an early diagnosis is often delayed due to unspecific clinical symptoms, and histological support is not always decisive to identify the diversity of tumors of the PR. The present study aimed to characterize 18 tumors of the PR using comparative genomic hybridization. All the tumors were primarily surgically resected without any previous irradiation or chemotherapy. In addition to chromosomal aberrations in PPT and different GCTs of the PR, the present study described, for the first time, the chromosomal changes in a few rare entities (solitary-fibrous and neuroendocrine tumors) of the PR. The tumors in the study, regardless of histology and World Health Organization grade, were characterized by frequent gains at 7, 9q, 12q, 16p, 17 and 22q, and losses at 13q. While the detection of chromosomal aberrations in these tumors appears not to be indicative enough of histological entities and their grade of malignancy, the present data may be of use to select genes of interest for higher resolution genomic analyses.
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Affiliation(s)
- FLORIAN BÖHRNSEN
- Clinic of Oral and Maxillofacial Surgery, Georg-August University Göttingen, Göttingen D-37075, Germany
| | - CHRISTINA ENDERS
- Institute of Pathology, Georg-August University Göttingen, Göttingen D-37075, Germany
| | - HANS-CHRISTOPH LUDWIG
- Department of Neurosurgery, Georg-August University Göttingen, Göttingen D-37075, Germany
| | - WOLFGANG BRÜCK
- Institute of Neuropathology, Georg-August University Göttingen, Göttingen D-37075, Germany
| | - LASZLO FÜZESI
- Institute of Pathology, Georg-August University Göttingen, Göttingen D-37075, Germany
| | - ANGELIKA GUTENBERG
- Department of Neurosurgery, Georg-August University Göttingen, Göttingen D-37075, Germany
- Department of Neurosurgery, Johannes Gutenberg University, Mainz D-76726, Germany
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Kalani MYS, Wilson DA, Koechlin NO, Abuhusain HJ, Dlouhy BJ, Gunawardena MP, Nozue-Okada K, Teo C. Pineal cyst resection in the absence of ventriculomegaly or Parinaud's syndrome: clinical outcomes and implications for patient selection. J Neurosurg 2015; 123:352-6. [DOI: 10.3171/2014.9.jns141081] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT
Surgical indications for patients with pineal cysts are controversial. While the majority of patients harboring a pineal cyst require no treatment, surgery is a well-accepted option for a subset of those patients with secondary hydrocephalus or Parinaud's syndrome. The majority of pineal cysts are identified incidentally during workup for other potential conditions, which may or may not be related to the presence of the cyst. In the absence of clear obstruction of CSF pathways, the treatment of presumed symptomatic pineal cysts is debatable. To clarify the role of surgery in these borderline cases, the authors reviewed their experience with resection of pineal cysts in the absence of ventriculomegaly or Parinaud's syndrome.
METHODS
The authors retrospectively reviewed medical records and imaging of all patients surgically treated between 2001 and 2014 with a pineal cyst in the absence of ventriculomegaly and Parinaud's syndrome. The presenting symptoms, preoperative cyst size, preoperative radiographic aqueductal compression, extent of resection, and radiographic and clinical follow-up were documented.
RESULTS
Eighteen patients (14 female and 4 male; mean age 24 years, range 4–47 years) underwent cyst resection in the absence of ventriculomegaly or Parinaud's syndrome. Presenting symptoms included headache (17 patients), visual disturbances (10 patients), gait instability (5 patients), dizziness (5 patients), episodic loss of consciousness (2 patients), and hypersomnolence (1 patient). The mean preoperative cyst diameter was 1.5 cm (range 0.9–2.2 cm). All patients had a complete resection. At a mean clinical follow-up of 19.1 months (range postoperative to 71 months), 17 (94%) patients had resolution or improvement of their presenting symptoms.
CONCLUSIONS
The authors' results suggest that ventriculomegaly and Parinaud's syndrome are not absolute requisites for a pineal cyst to be symptomatic. Analogous to colloid cysts of the third ventricle, intermittent occlusion of cerebrospinal fluid pathways may cause small pineal cysts to become intermittently symptomatic. A select cohort of patients with pineal cysts may benefit from surgery despite a lack of hydrocephalus or other obvious compressive pathology.
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Affiliation(s)
- M. Yashar S. Kalani
- 1Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
- 2Centre for Minimally Invasive Neurosurgery, Prince of Wales Hospital, Sydney, New South Wales, Australia; and
| | - David A. Wilson
- 1Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Nicolas Olmo Koechlin
- 2Centre for Minimally Invasive Neurosurgery, Prince of Wales Hospital, Sydney, New South Wales, Australia; and
| | - Hazem J. Abuhusain
- 2Centre for Minimally Invasive Neurosurgery, Prince of Wales Hospital, Sydney, New South Wales, Australia; and
| | - Brian J. Dlouhy
- 2Centre for Minimally Invasive Neurosurgery, Prince of Wales Hospital, Sydney, New South Wales, Australia; and
- 3Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | | | - Kyoko Nozue-Okada
- 2Centre for Minimally Invasive Neurosurgery, Prince of Wales Hospital, Sydney, New South Wales, Australia; and
| | - Charles Teo
- 2Centre for Minimally Invasive Neurosurgery, Prince of Wales Hospital, Sydney, New South Wales, Australia; and
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Deiana G, Mottolese C, Hermier M, Louis-Tisserand G, Berthezene Y. Imagery of pineal tumors. Neurochirurgie 2015; 61:113-22. [DOI: 10.1016/j.neuchi.2014.10.111] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 10/13/2014] [Accepted: 10/15/2014] [Indexed: 12/26/2022]
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Abstract
In recent years, the utilization of diagnostic imaging of the brain and spine in children has increased dramatically, leading to a corresponding increase in the detection of incidental findings of the central nervous system. Patients with unexpected findings on imaging are often referred for subspecialty evaluation. Even with rational use of diagnostic imaging and subspecialty consultation, the diagnostic process will always generate unexpected findings that must be explained and managed. Familiarity with the most common findings that are discovered incidentally on diagnostic imaging of the brain and spine will assist the pediatrician in providing counseling to families and in making recommendations in conjunction with a neurosurgeon, when needed, regarding additional treatments and prognosis.
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Jouvet A, Vasiljevic A, Champier J, Fèvre Montange M. Pineal parenchymal tumours and pineal cysts. Neurochirurgie 2015; 61:123-9. [DOI: 10.1016/j.neuchi.2013.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 04/12/2013] [Accepted: 04/15/2013] [Indexed: 12/25/2022]
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An Autopsy Case of Sudden Unexpected Death Due to a Glial Cyst of the Pineal Gland. Am J Forensic Med Pathol 2014; 35:186-8. [DOI: 10.1097/paf.0000000000000107] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Tamura Y, Yamada Y, Tucker A, Ukita T, Tsuji M, Miyake H, Kuroiwa T. Endoscopic surgery for hemorrhagic pineal cyst following antiplatelet therapy: case report. Neurol Med Chir (Tokyo) 2014; 53:625-9. [PMID: 24067776 PMCID: PMC4508677 DOI: 10.2176/nmc.cr2012-0396] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Pineal cysts of the third ventricle presenting with acute obstructive hydrocephalus due to internal cystic hemorrhage are a rare clinical entity. The authors report a case of a 61-year-old man taking antiplatelet medication who suffered from a hemorrhagic pineal cyst and was treated with endoscopic surgery. One month prior to treatment, the patient was diagnosed with a brainstem infarction and received clopidogrel in addition to aspirin. A small incidental pineal cyst was concurrently diagnosed using magnetic resonance (MR) imaging which was intended to be followed conservatively. The patient presented with a sudden onset of headache and diplopia. On admission, the neurological examination revealed clouding of consciousness and Parinaud syndrome. Computerized tomography (CT) scans demonstrated a hemorrhagic mass lesion in the posterior third ventricle. The patient underwent emergency external ventricular drainage with staged endoscopic biopsy and third ventriculostomy using a flexible videoscope. Histological examination revealed pineal tissue with necrotic change and no evidence of tumor cells. One year later MR imaging demonstrated no evidence of cystic lesion and a flow void between third ventricle and prepontine cistern. In patients with asymptomatic pineal cysts who are treated with antiplatelet therapy, it is important to be aware of the risk of pineal apoplexy. Endoscopic management can be effective for treatment of hemorrhagic pineal cyst with obstructive hydrocephalus.
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Affiliation(s)
- Yoji Tamura
- Department of Neurosurgery, Osaka Medical College
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de Jong MC, Moll AC, Göricke S, van der Valk P, Kors WA, Castelijns JA, de Graaf P. From a Suspicious Cystic Pineal Gland to Pineoblastoma in a Patient with Familial Unilateral Retinoblastoma. Ophthalmic Genet 2014; 37:116-8. [DOI: 10.3109/13816810.2014.929717] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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