High Prevalence of Pineal Cysts in Healthy Adults Demonstrated by High-Resolution, Noncontrast Brain MR Imaging

Pu, Yonglin; Mahankali, Srikanth; Hou, Jin; Li, Jinqi; Lancaster, Jack L.; Gao, Jie; Appelbaum, Daniel; Fox, Peter T.

doi:10.3174/ajnr.a0656

Cited by 106 publications

(57 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…1,3,12,22 These studies underscore the fact that the vast majority of pineal cysts are asymptomatic and have a benign natural history. In the largest and most recent study, Al-Holou and colleagues reviewed more than 48,000 adult patients undergoing brain MRI and discovered 478 incidental pineal cysts greater than 5 mm on MRI.…”

Section: Discussionmentioning

confidence: 94%

“…[1][2][3] Although commonly identified during workup for headaches, in the majority of cases, they are not the source of symptoms. [1][2][3]6,8,22 In rare cases, large cysts may obstruct the cerebral aqueduct, causing ventriculomegaly or compress the tectum, causing Parinaud's syndrome. 7,10,11,15,18,26 In our practice we have treated 3 patients who presented with hydrocephalus caused by compression of the aqueduct by a pineal cyst.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Pineal cyst resection in the absence of ventriculomegaly or Parinaud's syndrome: clinical outcomes and implications for patient selection

Kalani

Wilson

Koechlin

et al. 2015

JNS

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Pineal cyst resection in the absence of ventriculomegaly or Parinaud's syndrome: clinical outcomes and implications for patient selection

Kalani

Wilson

Koechlin

et al. 2015

JNS

View full text Add to dashboard Cite

show abstract

“…A female preponderance has been noted in most of the previous studies. 6,19,29,36,40,54,59,69 No large series has found a male predominance.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and natural history of pineal cysts in adults

Al-Holou¹,

Terman²,

Kilburg³

et al. 2011

JNS

View full text Add to dashboard Cite

Object We reviewed our experience with pineal cysts to define the natural history and clinical relevance of this common intracranial finding. Methods The study population consisted of 48,417 consecutive patients who underwent brain MR imaging at a single institution over a 12-year interval and who were over 18 years of age at the time of imaging. Patient characteristics, including demographic data and other intracranial diagnoses, were collected from cases involving patients with a pineal cyst. We then identified all patients with pineal cysts who had been clinically evaluated at our institution and who had at least 6 months of clinical and imaging follow-up. All inclusion criteria for the natural history analysis were met in 151 patients. Results Pineal cysts measuring 5 mm or larger in greatest dimension were found in 478 patients (1.0%). Of these, 162 patients were male and 316 were female. On follow-up MR imaging of 151 patients with pineal cyst at a mean interval of 3.4 years from the initial study, 124 pineal cysts remained stable, 4 increased in size, and 23 decreased in size. Cysts that were larger at the time of initial diagnosis were more likely to decrease in size over the follow-up interval (p = 0.004). Patient sex, patient age at diagnosis, and the presence of septations within the cyst were not significantly associated with cyst change on follow-up. Conclusions Follow-up imaging and neurosurgical evaluation are not mandatory for adults with asymptomatic pineal cysts.

show abstract

“…Second, pineal cysts are very common (4,6,7). Effects of pineal cysts on pineal function are not known.…”

mentioning

confidence: 99%

Pineal volume and circadian melatonin profile in healthy volunteers: An interdisciplinary approach

Nölte

Lütkhoff

Stuck

et al. 2009

Magnetic Resonance Imaging

View full text Add to dashboard Cite

Purpose: To correlate pineal parenchyma volume (PP) to circadian melatonin profiles and to determine the 24-hour melatonin per volume of pineal tissue (MLPV). Furthermore, we compared melatonin profiles of cystic and solid glands. Methods:In 15 healthy male subjects (20 -27 years) the PP was determined using high-resolution magnetic resonance imaging (trueFISP, isotropic voxel: 0.8 mm 3 ). Melatonin plasma concentrations (MC) were determined every 2 hours for 24 hours.Results: Mean PP was 125 Ϯ 54 mm 3 . PP correlated linearly to maximum MC and to 24-hour melatonin (r ϭ 0.61 and r ϭ 0.64, P Ͻ 0.05) but not to minimum MC. The 24-hour melatonin was 653 Ϯ 242.6 pg/mL, MLPV was 5.8 Ϯ 2.3 pg/mL*ml Ϫ1 . Nine pineal glands were solid and six were cystic. PP of solid glands showed higher linear correlations to maximum melatonin, to 24-hour melatonin, and to the slope of the melatonin increase of the curve (P Ͻ 0.05). Conclusion:PP correlates linearly to melatonin plasma concentrations in humans. MLPV displays similar interindividual differences as 24-hour melatonin. PP of solid glands show better correlation to melatonin profiles than cystic.

show abstract

High Prevalence of Pineal Cysts in Healthy Adults Demonstrated by High-Resolution, Noncontrast Brain MR Imaging

Cited by 106 publications

References 22 publications

Pineal cyst resection in the absence of ventriculomegaly or Parinaud's syndrome: clinical outcomes and implications for patient selection

Pineal cyst resection in the absence of ventriculomegaly or Parinaud's syndrome: clinical outcomes and implications for patient selection

Prevalence and natural history of pineal cysts in adults

Pineal volume and circadian melatonin profile in healthy volunteers: An interdisciplinary approach

Contact Info

Product

Resources

About