Benign large pineal cysts are rare lesions and sometimes difficult to distinguish from neoplastic cysts of the pineal region. Seven patients with cysts of the pineal region (1.5-2 cm diameter), treated stereotactically were identified by retrospective chart review. In all patients the cyst wall and contents were subjected to histopathological examination. In 2 patients stereotactic operation showed that secondary (neoplastic) cysts were ruled out. In 5 patients with symptomatic pineal cysts the stereotactic evacuation led to clinical recovery or marked improvement (mean follow-up 20 months). The previous literature is reviewed, aetiology, diagnostic work up and therapy discussed. We prefer the stereotactic management of cysts of the pineal region because it allows histological distinction of benign cysts from secondary cysts and is a safe, minimal invasive procedure.
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