The microsurgical management of benign pineal cysts: Helsinki experience in 60 cases

Abstract

Background: Microsurgical resection represents a well-accepted management option for symptomatic benign pineal cysts. Symptoms such as a headache, hydrocephalus, and visual deficiency are typically associated with pineal cysts. However, more recent studies reported over the past years have characterized additional symptoms as a part of the clinical manifestation of this disease and represent additional indications for intervention. Methods: We present a retrospective review of patients with histologically confirmed benign pineal cysts that were operated on in our department between 1997 and 2015. A demographic analysis, evaluation of preoperative status, surgical treatment, as well as immediate and long-term clinical and radiological outcomes were conducted. Results: A total of 60 patients with benign pineal cysts underwent surgery between 1997 and 2015. Gross total resection was achieved in 58 cases. All patients except one improved in their clinical status or had made a full recovery at the time of the last follow-up. The key steps for surgical resection of pineal cysts are reported, based on an analysis of representative surgical videos. Conclusions: We describe in this paper one of the largest series of microsurgically treated pineal cysts. In our opinion, judicious microsurgery remains the most suitable technique to effectively deal with this disease.

Systematic review of pineal cysts surgery in pediatric patients

“…We performed a descriptive analysis of the study population. For the study of the natural history of the disease, the preoperative presentation of the PCs was categorized into the following groups in correspondence with the PCs' diameters as proposed in our previous publication [22]: (1) PC patients with hydrocephalus; (2) PC patients with visual symptoms;…”

“…We report a summary of the retrospective evaluation of the histologically confirmed pediatric PC patients operated on in the Department of Neurosurgery, Helsinki University Hospital between 1997 and 2015. The research methodology used for this purpose was previously presented [22]. The systematic review of all surgically treated pediatric PC patients followed PRISMA guidelines.…”

“…Individual participant data was collected to organize the study characteristics table. Original languages of publications included Czech, German, and Japanese for one article each, Spanish in two publications, and English for the remainder [14,15,[20][21][22][23].…”

“…In our series, all PCs were reported as benign glial cysts by an experienced pathologist. As a reference, chromogranin stain positive in pineal parenchymal tumors remains negative for PCs [22,63].…”

“…As such, surgically treated pediatric PCs may represent a different and unique entity in clinical practice, which has not previously been properly investigated. Only a few large series on surgically treated PCs have been published in recent years [10][11][12][13][14][15][16][17][18][19][20][21][22], and no clinical study on surgically treated PCs in pediatric patients has been reported thus far. In 2013, a review on surgically treated PCs in children was performed.…”